Individual
DALE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1506 ALICE ST, WAYCROSS, GA 31501-4531
(912) 584-6500
Mailing address
4205 BELFORT RD STE 4015, JACKSONVILLE, FL 32216-3623
(904) 346-5426
(904) 346-0113
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
ME76518
FL
207Q00000X
Family Medicine Physician
48092
GA
207Q00000X
Family Medicine Physician
Primary
ME76518
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
261605000
—
FL
01
—
35915
BCBS
FL
01
—
930119999
RAILROAD MEDICARE
FL
Enumeration date
06/21/2006
Last updated
05/02/2024
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