Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 0021380 | TX |
N | 213EG0000X | General Practice | 0021380 | TX |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 21380 | TX |
NPI | 1053373175 |
---|---|
Provider Name | Dr. David Isaac Tucker |
First Address | Fort Sam Houston, TX 78234-6230 |
Second Address | Fort Sam Houston, TX 78234-6230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 01/10/2014 |