Provider Demographics
NPI:1609964394
Name:TUCKER, MARK O (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:O
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6513 PRESTON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2688
Mailing Address - Country:US
Mailing Address - Phone:972-608-2025
Mailing Address - Fax:972-608-2032
Practice Address - Street 1:6513 PRESTON RD
Practice Address - Street 2:SUITE 300
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-2688
Practice Address - Country:US
Practice Address - Phone:972-608-2025
Practice Address - Fax:972-608-2032
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-07-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXK7223208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L5697Medicare PIN