Provider Demographics
NPI:1497742936
Name:TUCKER, RALPH MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:MICHAEL
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 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:877-856-3774
Mailing Address - Fax:
Practice Address - Street 1:60 WESTMINSTER ST N
Practice Address - Street 2:SUITE A
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6518
Practice Address - Country:US
Practice Address - Phone:239-368-1808
Practice Address - Fax:239-368-4664
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME51024207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL08563OtherBC
FLME51024OtherFL LIC
FL08563UMedicare PIN