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General NPI Number Information
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NPI Number | 1396916912
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Entity Type | Organization
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Legal Business Name | SOMERS FAMILY PRACTICE, LLC
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Dates
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Enumeration Date | 03/24/2008
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 24 BATTLE STREET SUITE 1A
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City | SOMERS
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State | CT
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Zip | 06071
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Country | US
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Telephone | 860-749-8887
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Fax | 860-749-7421
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Provider Business Mailing Address
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Address Line | P.O. BOX 959
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City | SOMERS
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State | CT
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Zip | 06071
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Country | US
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Telephone | 860-749-8887
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Fax | 860-749-7421
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Authorized Official
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Title or Position | OWNER
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Name | DR. IAN STERLING TUCKER
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Credential | M.D.
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Telephone | 860-749-8887
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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 | 039732
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License Number State | CT
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