Provider Demographics
NPI:1295836625
Name:TUCKER, CORTEZ AUTHUR (M D)
Entity type:Individual
Prefix:
First Name:CORTEZ
Middle Name:AUTHUR
Last Name:TUCKER
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:TN
Mailing Address - Zip Code:38343-2921
Mailing Address - Country:US
Mailing Address - Phone:731-784-1975
Mailing Address - Fax:731-784-1245
Practice Address - Street 1:1803 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:TN
Practice Address - Zip Code:38343-2921
Practice Address - Country:US
Practice Address - Phone:731-784-1975
Practice Address - Fax:731-784-1245
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41806207LP2900X, 208VP0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN300491Medicaid
TN4226226OtherBCBS
TN30004913Medicare UPIN
FLU6062BMedicare ID - Type Unspecified
TN4226226OtherBCBS