Organization
GERIATRIC AND PRIMARY CARE SERVICES S C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLADSTONE A TUCKER MD (OWNER)
(618) 542-6152
Entity
Organization
Contact information
Practice address
1606 CASTLEBERRY DR, MARION, IL 62959-1586
(618) 997-9519
(618) 993-0592
Mailing address
PO BOX 752, CONCORDIA, MO 64020-0752
(660) 463-1365
(660) 463-1367
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
036111926
IL
Other
Enumeration date
08/12/2006
Last updated
07/25/2012
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