Individual
TARVEZ TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3098
(503) 418-4980
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3098
(503) 418-4980
Taxonomy
Speciality
Code
Description
License number
State
2084A2900X
Neurocritical Care Physician
Primary
MD 158051
OR
2084N0400X
Neurology Physician
MD158051
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500648851
—
OR
05
—
64096597
—
KY
Enumeration date
05/20/2006
Last updated
01/14/2017
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