Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | 140 | NC |
NPI | 1003818097 |
---|---|
Provider Name | Dr. David B Tucker |
First Address | Eden, NC 27288-5070 |
Second Address | Eden, NC 27288-5070 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 26/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T64039 | (02) | NC |
T64039 | (02) | VA |