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General NPI Number Information
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NPI Number | 1538344270
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Entity Type | Individual
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Provider Name | DOUGLAS ELIOT TUCKER M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 1498 SOLANO AVE
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City | ALBANY
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State | CA
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Zip | 94706-2148
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Country | US
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Telephone | 510-496-6077
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Fax | 510-848-8699
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Provider Business Mailing Address
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Address Line | 2887 COLLEGE AVE SUITE 108
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City | BERKELEY
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State | CA
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Zip | 94705-2154
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Country | US
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Telephone | 510-496-6077
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Fax | 510-848-8699
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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 | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | G054196
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | MD00047712
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G054196
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number |
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License Number State | IL
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