Organization
MICHAEL G. TUCKER, DPM
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL GEORGE TUCKER DPM (OWNER)
(979) 285-0505
Entity
Organization
Contact information
Practice address
450 THIS WAY ST, SUITE D, LAKE JACKSON, TX 77566-5152
(979) 285-0505
(979) 285-9355
Mailing address
450 THIS WAY ST, SUITE D, LAKE JACKSON, TX 77566-5152
(979) 285-0505
(979) 285-9355
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1302
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00T68L
BCBS
TX
05
—
127186802
—
TX
Enumeration date
05/20/2009
Last updated
05/20/2009
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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