Provider Demographics
NPI:1740500958
Name:TUCKER, JOSHUA ERIC (DO)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ERIC
Last Name:TUCKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 GREENO RD N
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-2914
Mailing Address - Country:US
Mailing Address - Phone:251-625-2228
Mailing Address - Fax:251-625-2112
Practice Address - Street 1:4105 HOSPITAL ST STE 112B
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581
Practice Address - Country:US
Practice Address - Phone:228-938-0700
Practice Address - Fax:228-938-0705
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1456208VP0014X
MS23604208VP0014X, 208100000X
ALDO1456208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08320701Medicaid