Provider Demographics
NPI:1982648820
Name:TUCKER, THOMAS BOYNTON (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BOYNTON
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:694 HILL COUNTRY DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-6078
Practice Address - Country:US
Practice Address - Phone:830-792-3434
Practice Address - Fax:830-257-5875
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60125712207RH0003X
TXG8995207RH0003X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX830004598OtherRAILROAD MEDICARE NUMBER
TX137630305Medicaid
TX137630312Medicaid
WA0263270OtherL&I
TX137630311Medicaid
WA2007043Medicaid
TX8BP220OtherBCBS OF TX
WAP01288316OtherRR MEDICARE
TX0811853-01Medicaid
TX137630311Medicaid
TX89553FMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
WA2007043Medicaid
TX137630305Medicaid
WAG8891536Medicare PIN
TX0811853-01Medicaid
TX137630312Medicaid