Provider Demographics
NPI:1124175286
Name:TUCKER, WILLIAM FULTON JR (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FULTON
Last Name:TUCKER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 12726
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-0726
Mailing Address - Country:US
Mailing Address - Phone:214-265-5050
Mailing Address - Fax:214-265-0505
Practice Address - Street 1:17051 DALLAS PKWY STE 420
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7115
Practice Address - Country:US
Practice Address - Phone:214-265-5050
Practice Address - Fax:214-265-0505
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8474207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
200024781OtherRAILROAD MEDICARE ID
TX00U59YOtherBCBS IDENTIFIER
TX116145703Medicaid
5812005OtherAETNA ID