Provider Demographics
NPI:1356430821
Name:TUCKER, WAYNE I (DO, PA)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:I
Last Name:TUCKER
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Gender:M
Credentials:DO, PA
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Mailing Address - Street 1:101 BECKS WOODS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3854
Mailing Address - Country:US
Mailing Address - Phone:302-838-1100
Mailing Address - Fax:302-838-8962
Practice Address - Street 1:101 BECKS WOODS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3854
Practice Address - Country:US
Practice Address - Phone:302-838-1100
Practice Address - Fax:302-838-8962
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2014-04-16
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Provider Licenses
StateLicense IDTaxonomies
DEC20004133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE510410516OtherTAX ID