Healthcare Provider Details

I. General information

NPI: 1144208224
Provider Name (Legal Business Name): JAMES C TUCKER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S MCKINLEY ST SUITE 102
LITTLE ROCK AR
72205
US

IV. Provider business mailing address

800 FAIR PARK BLVD
LITTLE ROCK AR
72204-1720
US

V. Phone/Fax

Practice location:
  • Phone: 501-666-2824
  • Fax: 501-666-9653
Mailing address:
  • Phone: 501-666-2824
  • Fax: 501-666-9653

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberC-7983
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: