MEDICARE: PAUL ANTHONY TUCKER II M.D.

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	207RI0011X	Interventional Cardiology Physician	H3951	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P00698690	OTHER	TX	MEDICARE RAILROAD
5	060020998	OTHER	TX	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8BX080	OTHER	TX	BCBSTX
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134104847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ANTHONY TUCKER II M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1509
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78295-1509
Country	:	US
Telephone Number	:	512-623-5300
Fax Number	:	512-623-5399

Provider Business Practice Location Address
First Line	:	4316 JAMES CASEY ST
Second Line	:	BUILDING C
City	:	AUSTIN
State	:	TX
Zip	:	78745-1116
Country	:	US
Telephone Number	:	512-623-5300
Fax Number	:	512-623-5399

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	01/28/2022

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