Individual
SCOTT L TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1345A WESTGATE CENTER DR, WINSTON-SALEM, NC 27103-2934
(336) 768-8483
(336) 768-1195
Mailing address
1345 WESTGATE CENTER DR STE A, WINSTON SALEM, NC 27103-3041
(336) 768-8483
(336) 768-1195
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
200001832740
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2086S0122X
TAXONOMY
NC
01
—
2325790
MEDICARE GROUP
NC
01
—
83956
BCBSNC
NC
05
—
8983956
—
NC
Enumeration date
05/31/2005
Last updated
10/22/2009
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