Healthcare Provider Details

I. General information

NPI: 1497744429
Provider Name (Legal Business Name): DANIEL R TUCKEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 06/10/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4389 BEAUFORT RD.
HAVELOCK NC
28532
US

IV. Provider business mailing address

PSC BOX 8023
CHERRY POINT NC
28533-5008
US

V. Phone/Fax

Practice location:
  • Phone: 252-466-0244
  • Fax: 252-466-0127
Mailing address:
  • Phone: 252-466-0244
  • Fax: 252-466-0127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301078791
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: