Provider Demographics
NPI:1326315243
Name:AARON BERNARD TUCKLER MD PA
Entity Type:Organization
Organization Name:AARON BERNARD TUCKLER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:TUCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD FACC
Authorized Official - Phone:305-598-6464
Mailing Address - Street 1:9570 SW 107TH AVE
Mailing Address - Street 2:SUITE # C-204
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2788
Mailing Address - Country:US
Mailing Address - Phone:305-598-6464
Mailing Address - Fax:305-598-6443
Practice Address - Street 1:9570 SW 107TH AVE
Practice Address - Street 2:SUITE # C-204
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2788
Practice Address - Country:US
Practice Address - Phone:305-598-6464
Practice Address - Fax:305-598-6443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109419174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14CJ7OtherBC/BS
FLME109419OtherFL LICENSE
FL1760771000OtherIND NPI