Healthcare Provider Details

I. General information

NPI: 1790904035
Provider Name (Legal Business Name): SAMUEL TUCKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 06/16/2020
Certification Date: 06/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 HAWKINS DR
SEARCY AR
72143-4802
US

IV. Provider business mailing address

2900 HAWKINS DR
SEARCY AR
72143-4802
US

V. Phone/Fax

Practice location:
  • Phone: 501-278-2800
  • Fax: 501-268-3946
Mailing address:
  • Phone: 501-278-2800
  • Fax: 501-268-3946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE5357
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: