Individual
WAYNE TUCKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3920 DUTCHMANS LN STE 315, LOUISVILLE, KY 40207-4702
(502) 583-8005
(502) 583-8025
Mailing address
6801 DIXIE HWY, STE 130, LOUISVILLE, KY 40258-3913
(502) 583-8005
(502) 583-8025
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
30849
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100373940
—
IN
05
—
64308497
—
KY
Enumeration date
07/06/2006
Last updated
09/13/2019
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