Provider Demographics
NPI:1376595629
Name:TUCKER, GRACE B (MD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:B
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-2079
Mailing Address - Country:US
Mailing Address - Phone:903-416-6000
Mailing Address - Fax:903-416-6183
Practice Address - Street 1:1014 MEMORIAL DR
Practice Address - Street 2:1ST FLOOR
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-2079
Practice Address - Country:US
Practice Address - Phone:903-416-6000
Practice Address - Fax:903-416-6183
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE5922207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116787602Medicaid
TX116787602Medicaid
B21376Medicare UPIN