Healthcare Provider Details

I. General information

NPI: 1548697436
Provider Name (Legal Business Name): R MICHAEL TUCKER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 WESTMINSTER ST N SUITE A
LEHIGH ACRES FL
33936-6518
US

IV. Provider business mailing address

8851 BOARDROOM CIR
FORT MYERS FL
33919-4888
US

V. Phone/Fax

Practice location:
  • Phone: 239-368-1808
  • Fax: 239-481-8150
Mailing address:
  • Phone: 239-481-7000
  • Fax: 239-433-8999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME51024
License Number StateFL

VIII. Authorized Official

Name: RALPH MICHAEL TUCKER
Title or Position: OWNER
Credential: MD
Phone: 239-481-7000