Provider Demographics
NPI:1275614935
Name:TUCKER, ELIZABETH M (DO)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:205 W BOUTZ RD
Mailing Address - Street 2:BLDG 1
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3259
Mailing Address - Country:US
Mailing Address - Phone:575-532-7000
Mailing Address - Fax:575-532-7006
Practice Address - Street 1:1212 9TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5842
Practice Address - Country:US
Practice Address - Phone:575-439-9997
Practice Address - Fax:575-439-8080
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2011-02-14
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Provider Licenses
StateLicense IDTaxonomies
NMA-1455-08208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM46579028Medicaid
NY02323742Medicaid
NM46579028Medicaid
NYG46969Medicare UPIN
NMNMA101293Medicare Oscar/Certification