Doctor Name: | DR. PATRICK EDWIN TUCKER |
NPI Number: | 1295749349 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 12549 |
Business Practice Address: | 2668 S Harper Rd Corinth, MS - 388346770 |
Business Phone Number: | 6622877138 |
Business Fax Number: | 6622877157 |
Mailing Address: | 2668 S Harper Rd, CORINTH |
State: | MS |
Postal Code: | 388346770 |
Phone Number: | 6622877138 |
Fax Number: | 6622877157 |
NPI Enumeration Date: | 07/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 12549 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |