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General NPI Number Information
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NPI Number | 1588866263
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Entity Type | Individual
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Provider Name | FRANK CHARLES TUCKER JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 01/06/2012
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Provider Practice Location Address
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Address Line | 954 GRAND CANAL ST
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City | GULF BREEZE
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State | FL
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Zip | 32563-3053
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Country | US
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Telephone | 850-934-9472
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Fax | 850-934-9472
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Provider Business Mailing Address
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Address Line | 954 GRAND CANAL ST
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City | GULF BREEZE
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State | FL
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Zip | 32563-3053
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Country | US
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Telephone | 850-934-9472
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Fax | 850-934-9472
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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 | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 23918
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME23918
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 23918
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License Number State | FL
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