MEDICARE: SCOTT L 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	208200000X	Plastic Surgery Physician	200001832740	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2325790	OTHER	NC	MEDICARE GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2086S0122X	OTHER	NC	TAXONOMY
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	83956	OTHER	NC	BCBSNC

General Provider Information

NPI Number	:	1063415362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SCOTT L TUCKER MD

Provider Business Mailing Address
First Line	:	1345 WESTGATE CENTER DR STE A
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-3041
Country	:	US
Telephone Number	:	336-768-8483
Fax Number	:	336-768-1195

Provider Business Practice Location Address
First Line	:	1345A WESTGATE CENTER DR
Second Line	:
City	:	WINSTON-SALEM
State	:	NC
Zip	:	27103-2934
Country	:	US
Telephone Number	:	336-768-8483
Fax Number	:	336-768-1195

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	10/22/2009

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Directions to “ SCOTT L TUCKER MD” Practice Location

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