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General NPI Number Information
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NPI Number | 1326072778
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Entity Type | Individual
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Provider Name | WILLIAM T. TUCKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 2004 BREMO RD STE. 201
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City | RICHMOND
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State | VA
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Zip | 23226-2442
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Country | US
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Telephone | 804-239-1640
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Fax | 804-239-1655
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Provider Business Mailing Address
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Address Line | 2004 BREMO RD STE. 201
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City | RICHMOND
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State | VA
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Zip | 23226-2442
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Country | US
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Telephone | 804-239-1640
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Fax | 804-239-1655
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101033528
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License Number State | VA
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