| Organization Name: | TUCKER BAG LLC |
| NPI Number: | 1336596345 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NATHAN JEFFREY PETERSEN (MEMBER) |
| Mailing Address: | 6370 W. Union Hills Dr. Glendale |
| State: | AZ US |
| Postal Code: | 85308 |
| Phone Number: | 6234143500 |
| Fax Number: | 6233742549 |
| NPI Enumeration Date: | 05/19/2016 |
| NPI Last Update Date: | 05/19/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 51043 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |