Healthcare Provider Details

I. General information

NPI: 1073703187
Provider Name (Legal Business Name): MICHAEL JAMES TUCKER JR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 03/24/2025
Certification Date: 03/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 MCCLELLAND BLVD
JOPLIN MO
64804-1640
US

IV. Provider business mailing address

PO BOX 3810
JOPLIN MO
64803-3810
US

V. Phone/Fax

Practice location:
  • Phone: 417-347-5400
  • Fax: 417-347-5709
Mailing address:
  • Phone: 417-347-5400
  • Fax: 417-347-5709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101017371
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2025004183
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: