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Individual

DR. LYNN MOORE TUCKER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
2728 SUNSET BLVD, SUITE 104, WEST COLUMBIA, SC 29169-4840
(803) 939-2722
(803) 939-2723
Mailing address
2728 SUNSET BLVD, SUITE 104, WEST COLUMBIA, SC 29169-4840
(803) 939-2722
(803) 939-2723

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
041695
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000721828B
GA
05
G41695
SC
Enumeration date
07/11/2005
Last updated
02/20/2013
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