Provider Demographics
NPI:1285749762
Name:TUCKER-HARRIS, SHIRLEY A (MD)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:TUCKER-HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:A
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:916-854-6666
Mailing Address - Fax:916-854-6844
Practice Address - Street 1:350 30TH ST.,
Practice Address - Street 2:SUITE 100
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3422
Practice Address - Country:US
Practice Address - Phone:510-204-8290
Practice Address - Fax:510-273-8977
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F16114Medicare UPIN
CA00A465452Medicare ID - Type Unspecified