Individual
BRUCE NICHOLSON TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3536 MENDOCINO AVE, STE 300, SANTA ROSA, CA 95403-3634
(707) 544-3411
(707) 544-0834
Mailing address
3536 MENDOCINO AVE, STE 200, SANTA ROSA, CA 95403-3634
(707) 575-6049
(707) 544-0834
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G44233
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G442330
BLUE SHIELD OF CALIFORNIA
—
05
—
00G442330
—
CA
01
—
P00420858
RAILROAD MEDICARE
CA
Enumeration date
08/23/2005
Last updated
02/07/2012
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