Individual
JOHN R. TUCKER III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
433 PLAZA ST, BOGALUSA, LA 70427-3729
(985) 730-6705
(985) 730-7183
Mailing address
400 MEMPHIS ST, BOGALUSA, LA 70427-3862
(985) 730-6705
(985) 730-6709
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10080R
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1985449
—
LA
Enumeration date
07/19/2006
Last updated
07/08/2007
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