Individual
JASON DAVID TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12312 COPPER WAY, SUITE 200, CHARLOTTE, NC 28277-3386
(980) 859-2340
(844) 830-8115
Mailing address
12312 COPPER WAY, SUITE 200, CHARLOTTE, NC 28277-3386
(980) 859-2340
(844) 830-8115
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
0101249850
VA
213ES0000X
Sports Medicine Podiatrist
Primary
01109
NC
Other
Enumeration date
07/28/2008
Last updated
11/03/2016
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