Individual
DR. DAVID JOHN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1101 JACKSON ST SW, GRAVETTE, AR 72736-9121
(479) 787-5221
(479) 787-5613
Mailing address
1101 JACKSON ST SW, GRAVETTE, AR 72736-9121
(479) 787-5221
(479) 787-5613
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
2013042315
MO
207Q00000X
Family Medicine Physician
Primary
R3698
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100061170A
—
OK
01
—
100726240D
OK MEDICAID GROUP NUMBER
OK
05
—
112423001
—
AR
05
—
202310207
—
MO
01
—
50654
AR BCBS
AR
01
—
P00144854
RAILROAD MEDICARE NUMBER
AR
01
—
P00894372
OCH RR MEDICARE
AR
Enumeration date
05/03/2006
Last updated
10/16/2023
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