Provider Demographics
NPI:1467820936
Name:TUCKER, ROBERT
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:TUCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4008 MEHAFFEY LN NE
Mailing Address - Street 2:
Mailing Address - City:SOLON
Mailing Address - State:IA
Mailing Address - Zip Code:52333-8985
Mailing Address - Country:US
Mailing Address - Phone:319-325-5150
Mailing Address - Fax:
Practice Address - Street 1:4008 MEHAFFEY LN NE
Practice Address - Street 2:
Practice Address - City:SOLON
Practice Address - State:IA
Practice Address - Zip Code:52333-8985
Practice Address - Country:US
Practice Address - Phone:319-325-5150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-14
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23747207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine