Provider Demographics
NPI:1750341913
Name:MATTOX, N TUCKER JR (MD)
Entity type:Individual
Prefix:DR
First Name:N TUCKER
Middle Name:
Last Name:MATTOX
Suffix:JR
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 1:454 TAYLOR RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-3563
Mailing Address - Country:US
Mailing Address - Phone:334-613-9000
Mailing Address - Fax:334-532-0056
Practice Address - Street 1:454 TAYLOR RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3563
Practice Address - Country:US
Practice Address - Phone:334-613-9000
Practice Address - Fax:334-532-0056
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.19617207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL0910074OtherUNITED HEALTHCARE
AL510-01296OtherBCBS
AL510-07508OtherBCBS
AL000037191Medicaid
AL009939304Medicaid
AL009939303Medicaid
200026242OtherRAILROAD MEDICARE
AL510-37191OtherBCBS
AL515-10572OtherBCBS
AL009939304Medicaid
AL510-01296OtherBCBS