Healthcare Provider Details

I. General information

NPI: 1013967421
Provider Name (Legal Business Name): JAMES B TUCKER ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 OLD NORTH RD
CAMDEN DE
19934-1241
US

IV. Provider business mailing address

302 OUTRIGGER WAY
MIDDLETOWN DE
19709-8976
US

V. Phone/Fax

Practice location:
  • Phone: 302-222-8098
  • Fax:
Mailing address:
  • Phone: 302-378-8066
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberJ3-0000048
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: