Healthcare Provider Details

I. General information

NPI: 1568776730
Provider Name (Legal Business Name): ELIZABETH M TUCKER DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2010
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: ELIZABETH M. TUCKER
Title or Position: PRESIDENT
Credential: D.O.
Phone: 575-921-5452