Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 04-43440 | KS |
N | 207X00000X | Orthopaedic Surgeon | 12208319-1205 | UT |
N | 207XS0117X | Orthopaedic Spine Surgeon | 12208319-1205 | UT |
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 12208319-1205 | UT |
NPI | 1023403789 |
---|---|
Provider Name | William A. Tucker |
First Address | Salt Lake City, UT 84108-1200 |
Second Address | Salt Lake City, UT 84108-1200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2015 |
Last Update Date | 20/12/2021 |