Provider Demographics
NPI:1518245695
Name:SPENCER P. TUCKER LLC
Entity Type:Organization
Organization Name:SPENCER P. TUCKER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN, OWNDER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-419-0052
Mailing Address - Street 1:42334 DELUXE PLZ STE 1
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1237
Mailing Address - Country:US
Mailing Address - Phone:985-419-0052
Mailing Address - Fax:985-419-0056
Practice Address - Street 1:42334 DELUXE PLZ STE 1
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1237
Practice Address - Country:US
Practice Address - Phone:985-419-0052
Practice Address - Fax:985-419-0056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-24
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty