Individual
MR. JUAN L TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CCP
Contact information
Practice address
6051 U S HIGHWAY 49, HATTIESBURG, MS 39401-7200
(601) 288-4243
Mailing address
6051 U S HIGHWAY 49, HATTIESBURG, MS 39401-7200
(601) 288-4243
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
242T00000X
—
MS
Enumeration date
07/20/2022
Last updated
07/20/2022
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