Provider Demographics
NPI:1912068677
Name:TUCKER, JOEL A (MD)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6300 E LAKE BLVD
Mailing Address - Street 2:STE. 301
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-6770
Mailing Address - Country:US
Mailing Address - Phone:228-230-2663
Mailing Address - Fax:228-206-1192
Practice Address - Street 1:1720A MEDICAL PARK DR
Practice Address - Street 2:SUITE 220
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532-2129
Practice Address - Country:US
Practice Address - Phone:228-392-9355
Practice Address - Fax:228-392-1781
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2017-03-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLTRN9064207X00000X
FLME106815207XS0114X
MS21487207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002486000Medicaid
FLDM204ZMedicare PIN