Healthcare Provider Details

I. General information

NPI: 1174273122
Provider Name (Legal Business Name): ANDREW DAVID TUCKER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2022
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 E MARKET PLACE DR STE 300C
SPANISH FORK UT
84660-1396
US

IV. Provider business mailing address

PO BOX 27128
SALT LAKE CITY UT
84127-0128
US

V. Phone/Fax

Practice location:
  • Phone: 801-465-2559
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number14286989-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: