Provider Demographics
NPI:1487639324
Name:TUCKER, DONALD TOMMY (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:TOMMY
Last Name:TUCKER
Suffix:
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 4767
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78502-4767
Mailing Address - Country:US
Mailing Address - Phone:956-362-5030
Mailing Address - Fax:956-362-5035
Practice Address - Street 1:1421 N COL ROWE BLVD STE A
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2304
Practice Address - Country:US
Practice Address - Phone:956-362-5030
Practice Address - Fax:956-362-5035
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG4063207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX136396214Medicaid
TX8S0675OtherBCBS
TXE05065Medicare UPIN
TXP00195602Medicare PIN
TX8D0771Medicare PIN