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General NPI Number Information
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NPI Number | 1083814297
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Entity Type | Individual
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Provider Name | JOHN D TUCKER
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Gender | Male
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Dates
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Enumeration Date | 07/25/2007
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 9985 SIERRA AVE BLDG. #3, DEPT. OF RADIOLOGY
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City | FONTANA
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State | CA
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Zip | 92335-6720
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Country | US
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Telephone | 909-427-7649
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Fax |
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Provider Business Mailing Address
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Address Line | 9985 SIERRA AVE BLDG. #3, DEPT. OF RADIOLOGY
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City | FONTANA
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State | CA
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Zip | 92335-6720
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Country | US
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Telephone |
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Fax |
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD28077
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 6251
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | MT190680
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A85484
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License Number State | CA
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