Provider Demographics
NPI:1629207253
Name:TUCKER, MATTHEW ALVA (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALVA
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-7720
Mailing Address - Fax:812-450-7730
Practice Address - Street 1:519 HARRIET ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1715
Practice Address - Country:US
Practice Address - Phone:812-450-7720
Practice Address - Fax:812-450-7730
Is Sole Proprietor?:No
Enumeration Date:2009-07-02
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN02004639A207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease