Individual
MYRA BETH TUCKERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1790 30TH ST, SUITE 308, BOULDER, CO 80301-1022
(303) 440-0205
(303) 440-0209
Mailing address
1790 30TH ST., SUITE 308, BOULDER, CO 80301
(303) 440-0205
(303) 440-0209
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
45139
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0191671
—
OH
01
—
080188923
RAILROAD MEDICARE
—
Enumeration date
09/12/2005
Last updated
08/15/2008
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