Provider Demographics
NPI:1639113822
Name:TUCKER, ROBERT P III (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:TUCKER
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:9875 MEDLOCK BRIDGE PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022
Mailing Address - Country:US
Mailing Address - Phone:770-813-0026
Mailing Address - Fax:770-813-0029
Practice Address - Street 1:9875 MEDLOCK BRIDGE PARKWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:770-813-0026
Practice Address - Fax:770-813-0029
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2010-06-04
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Provider Licenses
StateLicense IDTaxonomies
GA024111207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D46357Medicare UPIN
GA18BDFVNMedicare ID - Type Unspecified