Healthcare Provider Details

I. General information

NPI: 1275614935
Provider Name (Legal Business Name): ELIZABETH M TUCKER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 9TH ST SUITE A
ALAMOGORDO NM
88310-5842
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3259
US

V. Phone/Fax

Practice location:
  • Phone: 575-439-9997
  • Fax: 575-439-8080
Mailing address:
  • Phone: 575-532-7000
  • Fax: 575-532-7006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA-1455-08
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: