Provider Demographics
NPI:1548219975
Name:TUCKER, SHARON E (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:E
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1650 REPUBLIC PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6916
Mailing Address - Country:US
Mailing Address - Phone:972-682-4100
Mailing Address - Fax:972-270-9637
Practice Address - Street 1:1650 REPUBLIC PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6916
Practice Address - Country:US
Practice Address - Phone:972-682-4100
Practice Address - Fax:972-270-9637
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080091150OtherRR MEDICARE
TX1172850-01Medicaid
TX080091150OtherRR MEDICARE
TXF92948Medicare UPIN