Provider Demographics
NPI:1134104847
Name:TUCKER, PAUL ANTHONY II (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:TUCKER
Suffix:II
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:PO BOX 1509
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78295-1509
Mailing Address - Country:US
Mailing Address - Phone:512-623-5300
Mailing Address - Fax:512-623-5399
Practice Address - Street 1:4316 JAMES CASEY ST
Practice Address - Street 2:BUILDING C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1116
Practice Address - Country:US
Practice Address - Phone:512-623-5300
Practice Address - Fax:512-623-5399
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3951207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX119097705Medicaid
TX119097704Medicaid
TX8BX080OtherBCBSTX
TXP00698690OtherMEDICARE RAILROAD
TX060020998OtherMEDICARE RAILROAD
TX119097701Medicaid
TX119097704Medicaid
TXP00698690OtherMEDICARE RAILROAD
TX119097701Medicaid
TX119097705Medicaid