Provider Demographics
NPI:1700048683
Name:TUCKER, ANTHONY TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:TODD
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CYPRESS EDGE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32164-8411
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:120 CYPRESS EDGE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-8411
Practice Address - Country:US
Practice Address - Phone:386-586-4462
Practice Address - Fax:386-586-4463
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-01
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPENDING207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology