Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | C-7983 | AR |
NPI | 1144208224 |
---|---|
Provider Name | Dr. James C Tucker JR. |
First Address | Little Rock, AR 72204-1720 |
Second Address | Little Rock, AR 72205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2006 |
Last Update Date | 06/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130744001 | (05) | AR |
5B365C207 | MEDICARE (01) | AR |
F62665 | (02) | AR |