Doctor Name: | STEPHEN R TUCKER |
NPI Number: | 1538179247 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 276502-1205 |
Business Practice Address: | 1054 E Millbrook Way Bountiful, UT - 840102024 |
Business Phone Number: | 8016608687 |
Business Fax Number: | 8663328067 |
Mailing Address: | 307 W. 200 S., Ste 3006, C/o Alta Management Solutions SALT LAKE CITY |
State: | UT |
Postal Code: | 841011259 |
Phone Number: | 8015050821 |
Fax Number: | 8015050803 |
NPI Enumeration Date: | 08/08/2006 |
NPI Last Update Date: | 11/22/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 276502-1205 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |