Provider Demographics
NPI:1568747244
Name:LAWRENCE V. TUCKER, M.D., PLLC
Entity Type:Organization
Organization Name:LAWRENCE V. TUCKER, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:VERNON
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-972-2178
Mailing Address - Street 1:5000 LEGACY DR
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3100
Mailing Address - Country:US
Mailing Address - Phone:972-473-7628
Mailing Address - Fax:972-473-7699
Practice Address - Street 1:5000 LEGACY DR
Practice Address - Street 2:SUITE 400
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3100
Practice Address - Country:US
Practice Address - Phone:972-473-7628
Practice Address - Fax:972-473-7699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-13
Last Update Date:2012-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA840672084A0401X, 2084P0800X
TXP08832084A0401X, 2084B0040X, 2084P0800X, 2084P2900X, 2084S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
No2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & NeuropsychiatryGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No2084S0010XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
I38963Medicare UPIN