Healthcare Provider Details

I. General information

NPI: 1922033471
Provider Name (Legal Business Name): MICHAEL SCOTT TUCKER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/15/2020
Certification Date: 01/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9125 CORSEA DEL FONTANA WAY SUITE 100
NAPLES FL
34109-4396
US

IV. Provider business mailing address

2143 MARINA DR
NAPLES FL
34102-7627
US

V. Phone/Fax

Practice location:
  • Phone: 239-598-4004
  • Fax:
Mailing address:
  • Phone: 239-262-6843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME73990
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: