Provider Demographics
NPI:1003818097
Name:TUCKER, DAVID B (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:B
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 S VAN BUREN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5070
Mailing Address - Country:US
Mailing Address - Phone:336-627-4861
Mailing Address - Fax:336-623-4411
Practice Address - Street 1:519 S VAN BUREN RD
Practice Address - Street 2:SUITE D
Practice Address - City:EDEN
Practice Address - State:NC
Practice Address - Zip Code:27288-5070
Practice Address - Country:US
Practice Address - Phone:336-627-4861
Practice Address - Fax:336-623-4411
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC140213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA480000121Medicare PIN
NCT64039Medicare UPIN
VAT64039Medicare UPIN
NC243072BMedicare PIN
VA0611010005Medicare NSC
NC0611010003Medicare NSC