Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 0101234827 | VA |
NPI | 1265639306 |
---|---|
Provider Name | Elliot Moore Tucker |
First Address | Norfolk, VA 23507-1910 |
Second Address | Norfolk, VA 23507-1910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2007 |
Last Update Date | 19/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02032548 | (05) | MS |
1193186 | (05) | LA |
1265639306 | (05) | VA |
89066JW | (05) | NC |