Provider Demographics
NPI:1275556193
Name:TUCKER, WILLIAM STUART JR (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STUART
Last Name:TUCKER
Suffix:JR
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 60099
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0099
Mailing Address - Country:US
Mailing Address - Phone:704-512-5000
Mailing Address - Fax:704-512-5001
Practice Address - Street 1:330 BILLINGSLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-5055
Practice Address - Country:US
Practice Address - Phone:704-512-5000
Practice Address - Fax:704-512-5001
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27861207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7983930Medicaid
NC110214042OtherMEDICARE RAILROAD
SCN27861Medicaid
NC1275556193Medicaid
NC2274975AMedicare PIN
NC2274975BMedicare PIN
NCE11612Medicare UPIN
NC2274975CMedicare PIN