Individual
MR. JASON MARK TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1400 MERCY DR STE 100, MUSKEGON, MI 49444-1833
(231) 733-1326
Mailing address
6441 PINE VALLEY RD, CLARKSTON, MI 48346-2231
(248) 202-3069
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601010459
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/10/2019
Last updated
05/21/2021
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