Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 9945R | LA |
NPI | 1134235989 |
---|---|
Provider Name | Dr. Victor E Tuckler |
First Address | Jefferson, LA 70121-1527 |
Second Address | Jefferson, LA 70121-1527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G00656 | (02) |