Provider Demographics
NPI:1538154612
Name:TUCKER, DUANE CARLTON (MD)
Entity type:Individual
Prefix:DR
First Name:DUANE
Middle Name:CARLTON
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 41
Mailing Address - Street 2:BOX 1952
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09464
Mailing Address - Country:US
Mailing Address - Phone:01144147-346-1138
Mailing Address - Fax:
Practice Address - Street 1:PSC 41
Practice Address - Street 2:BOX 1952
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09464-0020
Practice Address - Country:US
Practice Address - Phone:01144147-346-1138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME133817207N00000X
CAGFE42087207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022380200Medicaid