Individual
CLINT M TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
310 E BROADWAY, SUITE 200, LOUISVILLE, KY 40202-1745
(502) 585-5249
(502) 585-5251
Mailing address
310 E BROADWAY, SUITE 200, LOUISVILLE, KY 40202-1745
(502) 585-5249
(502) 585-5251
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
46666
KY
207R00000X
Internal Medicine Physician
164546
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000867381
ANTHEM
KY
01
—
1728238
CIGNA
—
Enumeration date
04/14/2010
Last updated
08/17/2015
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