Individual
DERON TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7243 TANAGER ST, HOBART, IN 46342-6948
(219) 256-2030
Mailing address
7243 TANAGER ST, HOBART, IN 46342-6948
(219) 256-2030
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
5360094917
IN
Other
Enumeration date
06/06/2015
Last updated
06/06/2015
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