Healthcare Provider Details

I. General information

NPI: 1013987643
Provider Name (Legal Business Name): JOSHUA ALAN TUCK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5401 PEACH ST SUITE 3300
ERIE PA
16509-2601
US

IV. Provider business mailing address

1 LECOM PL
ERIE PA
16505-2571
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-7840
  • Fax: 814-868-2139
Mailing address:
  • Phone:
  • Fax: 814-868-2522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberOS014617
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS014617
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: