MEDICARE: MARK REID TUCKER 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	207W00000X	Ophthalmology Physician	16404	AL

General Provider Information

NPI Number	:	1427006717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK REID TUCKER M.D.

Provider Business Mailing Address
First Line	:	3368 HIGHWAY 280
Second Line	:	SUITE 215
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-3393
Country	:	US
Telephone Number	:	256-329-9064
Fax Number	:	256-329-0262

Provider Business Practice Location Address
First Line	:	3368 HIGHWAY 280
Second Line	:	SUITE 215
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-3393
Country	:	US
Telephone Number	:	256-329-9064
Fax Number	:	256-329-0262

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

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	07/08/2007

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Directions to “ MARK REID TUCKER M.D.” Practice Location

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