Provider Demographics
NPI:1548782758
Name:TUCKER, WILLIAM GRIFFIN (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GRIFFIN
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 KINGSWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9647
Mailing Address - Country:US
Mailing Address - Phone:270-465-3812
Mailing Address - Fax:
Practice Address - Street 1:219 MEADER STREET, VILLAGE J
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-4271
Practice Address - Country:US
Practice Address - Phone:270-789-6112
Practice Address - Fax:270-789-6094
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-10
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR4262207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty