# JASON DAVID TUCKER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1689839813
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 0101249850 | VA | — |
| 213ES0000X | Sports Medicine Podiatrist | 01109 | NC | Yes |

## Other

- **Enumeration date:** 07/28/2008
- **Last updated:** 11/03/2016