Provider Demographics
NPI:1679888226
Name:WILLIAM F TUCKER JR MD PA
Entity type:Organization
Organization Name:WILLIAM F TUCKER JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:214-265-5050
Mailing Address - Street 1:8440 WALNUT HILL LN
Mailing Address - Street 2:SUITE 250
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75231-3833
Mailing Address - Country:US
Mailing Address - Phone:214-265-5050
Mailing Address - Fax:214-265-0505
Practice Address - Street 1:8210 WALNUT HILL LN
Practice Address - Street 2:SUITE 404
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4405
Practice Address - Country:US
Practice Address - Phone:214-265-5050
Practice Address - Fax:214-265-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-06
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNH8474207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
200024781OtherRAILROAD MEDICARE PROVIDER ID
5812005OtherAETNA PROVIDER ID
TX116145703Medicaid
4970894OtherCIGNA PROVIDER ID
200024781OtherRAILROAD MEDICARE PROVIDER ID
00U59YMedicare PIN