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General NPI Number Information
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NPI Number | 1518245695
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Entity Type | Organization
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Legal Business Name | SPENCER P. TUCKER LLC
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Dates
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Enumeration Date | 07/24/2011
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Last Update Date | 07/24/2011
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Provider Practice Location Address
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Address Line | 42334 DELUXE PLZ STE 1
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City | HAMMOND
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State | LA
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Zip | 70403-1237
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Country | US
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Telephone | 985-419-0052
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Fax | 985-419-0056
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Provider Business Mailing Address
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Address Line | 42334 DELUXE PLZ STE 1
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City | HAMMOND
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State | LA
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Zip | 70403-1237
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Country | US
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Telephone | 985-419-0052
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Fax | 985-419-0056
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Authorized Official
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Title or Position | PHYSICIAN, OWNDER
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Name | SPENCER TUCKER
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Credential | MD
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Telephone | 985-419-0052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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