Individual
CHARLES DOUGLAS TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4007 WISWELL RD W, MURRAY, KY 42071
(270) 753-8724
Mailing address
4007 WISWELL RD W, MURRAY, KY 42071-4492
(270) 293-7019
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
22873
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64228737
—
KY
01
—
6885
MEDICARE GROUP
KY
01
—
CK4330
MEDICARE RAILROAD
KY
Enumeration date
12/05/2006
Last updated
07/25/2024
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