Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 05-21674 | KS |
NPI | 1003858192 |
---|---|
Provider Name | David A Tucker |
First Address | Emeryville, CA 94608-1844 |
Second Address | Wichita, KS 67218-3713 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 14/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B69211 | (02) | KS |