MEDICARE: DR. GLADSTONE A TUCKER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208M00000X	Hospitalist Physician	036111926	IL
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	036111926	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00239844	OTHER	IL	MEDICARE - RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	252364	OTHER	IL	HARMONY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	07332006	OTHER	IL	BCBS
4	229260	OTHER	IL	COVENTRY
6	699628	OTHER	IL	HEALTHLINK
7	9367182	OTHER	IL	CIGNA

General Provider Information

NPI Number	:	1023087012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLADSTONE A TUCKER MD

Provider Business Mailing Address
First Line	:	PO BOX 752
Second Line	:
City	:	CONCORDIA
State	:	MO
Zip	:	64020-0752
Country	:	US
Telephone Number	:	660-463-1365
Fax Number	:	660-463-1367

Provider Business Practice Location Address
First Line	:	1606 CASTLEBERRY DR
Second Line	:
City	:	MARION
State	:	IL
Zip	:	62959-1586
Country	:	US
Telephone Number	:	618-997-9519
Fax Number	:	618-993-0592

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	05/25/2023

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Directions to “ DR. GLADSTONE A TUCKER MD” Practice Location

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