Individual
TUCKER GREENE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
636 DEL PRADO BLVD S, CAPE CORAL, FL 33990-2668
(239) 772-6513
Mailing address
6896 W SNOWVILLE RD, BRECKSVILLE, OH 44141-3214
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME76719
FL
207PE0005X
Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
ME76719
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
218034
AMERIGROUP
FL
05
—
255763100
—
FL
01
—
44859
BLUE CROSS BLUE SHIELD
FL
01
—
5268640
AETNA
FL
Enumeration date
04/19/2006
Last updated
05/29/2024
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