Healthcare Provider Details

I. General information

NPI: 1124029178
Provider Name (Legal Business Name): JON BARRY TUCKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 BOWER HILL RD SUITE 100
PITTSBURGH PA
15243-1324
US

IV. Provider business mailing address

1000 BOWER HILL RD AFFILIATE BILLING
PITTSBURGH PA
15243-1873
US

V. Phone/Fax

Practice location:
  • Phone: 412-276-0267
  • Fax: 412-276-7215
Mailing address:
  • Phone: 412-942-2533
  • Fax: 412-942-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD034772E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: