Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 2008-00963 | NC |
N | 2086S0129X | Vascular Surgeon | A85121 | CA |
N | 2086S0129X | Vascular Surgeon | T0964 | TX |
NPI | 1144487562 |
---|---|
Provider Name | Dr. Sonny W. Tucker JR. |
First Address | Durham, NC 27710-0001 |
Second Address | Durham, NC 27710-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2008 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5909467 | (05) | NC |