Provider Demographics
NPI:1194925545
Name:TUCKER, RUBY M (MD)
Entity type:Individual
Prefix:DR
First Name:RUBY
Middle Name:M
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4876 BAXTER RD
Mailing Address - Street 2:
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-671-7777
Mailing Address - Fax:757-671-7778
Practice Address - Street 1:4876 BAXTER RD
Practice Address - Street 2:
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-671-7777
Practice Address - Fax:757-671-7778
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101225807207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101225807OtherSTATE LICENSE