Provider Demographics
NPI:1497054068
Name:AARON TUCKLER MDPA
Entity Type:Organization
Organization Name:AARON TUCKLER MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-598-6464
Mailing Address - Street 1:9570 SW 107TH AVE # C204
Mailing Address - Street 2:
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 # C204
Practice Address - Street 2:
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:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL037558261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL95607Medicare PIN