Individual
BRENT AUSTIN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
C06263
MD
363AM0700X
Medical Physician Assistant
C06263
MD
363AS0400X
Surgical Physician Assistant
Primary
C06263
MD
Other
Enumeration date
10/26/2016
Last updated
10/15/2019
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