Provider Demographics
NPI:1982820619
Name:TUCKER, WILBUR CAREY (MD)
Entity Type:Individual
Prefix:
First Name:WILBUR
Middle Name:CAREY
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:W.
Other - Middle Name:CAREY
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:23933 CREEK BRANCH LN
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4011
Mailing Address - Country:US
Mailing Address - Phone:239-390-0310
Mailing Address - Fax:239-390-0310
Practice Address - Street 1:23933 CREEK BRANCH LN
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4011
Practice Address - Country:US
Practice Address - Phone:239-390-0310
Practice Address - Fax:239-390-0310
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014497E207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology