MEDICARE: AARON BERNARD TUCKLER 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	ME109419	FL

General Provider Information

NPI Number	:	1760771000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AARON BERNARD TUCKLER M.D.

Provider Business Mailing Address
First Line	:	9570 SW 107TH AVE
Second Line	:	SUITE C- 204
City	:	MIAMI
State	:	FL
Zip	:	33176-2788
Country	:	US
Telephone Number	:	305-598-6464
Fax Number	:	305-598-6443

Provider Business Practice Location Address
First Line	:	9570 SW 107TH AVE
Second Line	:	SUITE C- 204
City	:	MIAMI
State	:	FL
Zip	:	33176-2788
Country	:	US
Telephone Number	:	305-598-6464
Fax Number	:	305-598-6443

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

Provider Enumeration Date	:	04/06/2011
Last Update Date	:	04/06/2011

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