Individual
BRADLEY DAVID TUCKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
245 E HUDSON DR, ELK RIDGE, UT 84651-9506
(801) 669-4297
Mailing address
4403 HARRISON BLVD STE 4400, OGDEN, UT 84403-3290
(801) 387-4550
(801) 387-4565
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8818148-1206
UT
Other
Enumeration date
05/19/2020
Last updated
12/06/2022
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