MEDICARE: LAUREL M 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	207Q00000X	Family Medicine Physician	K6375	TX

General Provider Information

NPI Number	:	1528063633
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL M TUCKER M.D.

Provider Business Mailing Address
First Line	:	10497 TOWN AND COUNTRY WAY
Second Line	:	STE 360
City	:	HOUSTON
State	:	TX
Zip	:	77024-1143
Country	:	US
Telephone Number	:	713-341-2100
Fax Number	:	713-932-7072

Provider Business Practice Location Address
First Line	:	10497 TOWN AND COUNTRY WAY
Second Line	:	STE 360
City	:	HOUSTON
State	:	TX
Zip	:	77024-1143
Country	:	US
Telephone Number	:	713-341-2100
Fax Number	:	713-932-7072

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

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/12/2010

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