Individual
DR. CHRISTOPHER JOHN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2535 IRA E WOODS AVENUE, GRAPEVINE, TX 76051-3930
(817) 481-2121
(817) 488-4493
Mailing address
2535 IRA E WOODS AVENUE, GRAPEVINE, TX 76051-3930
(817) 481-2121
(817) 488-4493
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
J2823
TX
208100000X
Physical Medicine & Rehabilitation Physician
J2828
TX
208VP0000X
Pain Medicine Physician
J2823
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
098913901
—
TX
01
—
82X724
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/21/2005
Last updated
04/27/2020
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