Healthcare Provider Details

I. General information

NPI: 1922295831
Provider Name (Legal Business Name): CAREY M TUCKER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 GOLF COURSE RD NW STE A3
ALBUQUERQUE NM
87120-5803
US

IV. Provider business mailing address

2145 E BASELINE RD
TEMPE AZ
85283-1515
US

V. Phone/Fax

Practice location:
  • Phone: 505-800-7070
  • Fax:
Mailing address:
  • Phone: 888-286-3606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3707
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: