Provider Demographics
NPI:1558479162
Name:DR PAMELA TUCK LLC
Entity Type:Organization
Organization Name:DR PAMELA TUCK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:P
Authorized Official - Last Name:TUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-396-7865
Mailing Address - Street 1:300 TAYLOR RD
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3521
Mailing Address - Country:US
Mailing Address - Phone:334-396-7865
Mailing Address - Fax:334-396-7868
Practice Address - Street 1:300 TAYLOR RD
Practice Address - Street 2:SUITE 600
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3521
Practice Address - Country:US
Practice Address - Phone:334-396-7865
Practice Address - Fax:334-396-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023723208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALK806OtherMEDICARE
H45483Medicare UPIN