Provider Demographics
NPI:1124029178
Name:TUCKER, JON BARRY (MD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:BARRY
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BOWER HILL RD
Mailing Address - Street 2:AFFILIATE BILLING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-1873
Mailing Address - Country:US
Mailing Address - Phone:412-942-2533
Mailing Address - Fax:412-942-2589
Practice Address - Street 1:1082 BOWER HILL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15243-1324
Practice Address - Country:US
Practice Address - Phone:412-276-0267
Practice Address - Fax:412-276-7215
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034772E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012291940005Medicaid
E55889Medicare UPIN
PA0012291940005Medicaid