Individual
DR. GARY JACKSON TUCKER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
418 COLEGATE DR, MARIETTA, OH 45750-9549
(740) 568-0412
(740) 568-0413
Mailing address
418 COLEGATE DR, MARIETTA, OH 45750-9549
(740) 568-0412
(740) 568-0413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
18392
WV
207Q00000X
Family Medicine Physician
Primary
35.098674
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0054604000
—
WV
05
—
0193633
—
OH
01
—
P01036081
MEDICARE RAILROAD
OH
Enumeration date
03/07/2006
Last updated
02/20/2015
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