Provider Demographics
NPI:1538344270
Name:TUCKER, DOUGLAS ELIOT (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ELIOT
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 1:2887 COLLEGE AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2154
Mailing Address - Country:US
Mailing Address - Phone:510-496-6077
Mailing Address - Fax:510-848-8699
Practice Address - Street 1:1498 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2148
Practice Address - Country:US
Practice Address - Phone:510-496-6077
Practice Address - Fax:510-848-8699
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0541962084F0202X, 2084P0800X
WAMD000477122084F0202X
IL2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry