Provider Demographics
NPI:1912876798
Name:THOMPSONTUCKER, ANTHONY GLEN (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:GLEN
Last Name:THOMPSONTUCKER
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 1:20023 MIDTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-3119
Mailing Address - Country:US
Mailing Address - Phone:424-204-2117
Mailing Address - Fax:
Practice Address - Street 1:20023 MIDTOWN AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-3119
Practice Address - Country:US
Practice Address - Phone:424-204-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-31
Last Update Date:2025-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty