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General NPI Number Information
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NPI Number | 1922295831
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Entity Type | Individual
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Provider Name | CAREY M TUCKER PA
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Gender | Male
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 8201 GOLF COURSE RD NW STE A3
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City | ALBUQUERQUE
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State | NM
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Zip | 87120-5803
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Country | US
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Telephone | 505-800-7070
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Fax |
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Provider Business Mailing Address
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Address Line | 2145 E BASELINE RD
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City | TEMPE
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State | AZ
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Zip | 85283-1515
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Country | US
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Telephone | 888-286-3606
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 3707
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License Number State | AZ
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