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General NPI Number Information
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NPI Number | 1023087012
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Entity Type | Individual
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Provider Name | GLADSTONE A TUCKER MD
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Gender | Male
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 05/25/2023
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Provider Practice Location Address
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Address Line | 1606 CASTLEBERRY DR
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City | MARION
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State | IL
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Zip | 62959-1586
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Country | US
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Telephone | 618-997-9519
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Fax | 618-993-0592
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Provider Business Mailing Address
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Address Line | PO BOX 752
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City | CONCORDIA
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State | MO
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Zip | 64020-0752
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Country | US
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Telephone | 660-463-1365
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Fax | 660-463-1367
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 036111926
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 036111926
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License Number State | IL
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