Healthcare Provider Details

I. General information

NPI: 1568747244
Provider Name (Legal Business Name): LAWRENCE V. TUCKER, M.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2011
Last Update Date: 12/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 LEGACY DR SUITE 400
PLANO TX
75024-3100
US

IV. Provider business mailing address

5000 LEGACY DR SUITE 400
PLANO TX
75024-3100
US

V. Phone/Fax

Practice location:
  • Phone: 972-473-7628
  • Fax: 972-473-7699
Mailing address:
  • Phone: 972-473-7628
  • Fax: 972-473-7699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberA84067
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License NumberP0883
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberP0883
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA84067
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberP0883
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberP0883
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code2084S0010X
TaxonomySports Medicine (Psychiatry & Neurology) Physician
License NumberP0883
License Number StateTX

VIII. Authorized Official

Name: DR. LAWRENCE VERNON TUCKER
Title or Position: CEO/PSYCHIATRIST
Credential: M.D.
Phone: 888-972-2178