Individual
DR. EDWARD O TACKEY
Active
Individual
DR. EDWARD O TACKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD24622
OR
207RR0500X
Rheumatology Physician
0101243144
VA
207RR0500X
Rheumatology Physician
Primary
C1-0023857
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1669488110
—
VA
05
—
227217
—
OR
01
—
P00621111
MEDICARE RAILROAD
VA
Enumeration date
08/01/2006
Last updated
08/26/2020
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