Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0129X | Vascular Surgeon | 00009762 | AL |
Y | 2086S0129X | Vascular Surgeon | ME69865 | FL |
NPI | 1063407567 |
---|---|
Provider Name | John A Tucker |
First Address | Pensacola, FL 32514 |
Second Address | Pensacola, FL 32514-6050 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 03/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
251301300 | (05) | FL |
C71063 | (02) |