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NPI Code Detail

MEDICARE: RON L TUCKMAN MD

MEDICARE: RON L TUCKMAN 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
1208000000XPediatrics Physician27245AZ

General Provider Information

NPI Number : 1184616997
Entity Type Code : Individual
Provider Name (Legal Business Name) : RON L TUCKMAN MD
Provider Business Mailing Address
First Line : 77 W FOREST AVE
Second Line : SUITE 304
City : FLAGSTAFF
State : AZ
Zip : 86001-1479
Country : US
Telephone Number : 928-214-3600
Fax Number : 928-214-3601
Provider Business Practice Location Address
First Line : 77 W FOREST AVE
Second Line : SUITE 304
City : FLAGSTAFF
State : AZ
Zip : 86001-1479
Country : US
Telephone Number : 928-214-3600
Fax Number : 928-214-3601
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2005
Last Update Date : 07/08/2007

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Directions to “ RON L TUCKMAN MD” Practice Location

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