Healthcare Provider Details

I. General information

NPI: 1114186053
Provider Name (Legal Business Name): JAMES JORDAN TUCKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 S SHACKLEFORD RD
LITTLE ROCK AR
72211-4335
US

IV. Provider business mailing address

PO BOX 2121
LOWELL AR
72745-2121
US

V. Phone/Fax

Practice location:
  • Phone: 501-219-7000
  • Fax: 501-614-3620
Mailing address:
  • Phone: 501-219-7000
  • Fax: 501-614-3620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number206713
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-9064
License Number StateAR
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMT196347
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: