Provider Demographics
NPI:1316986805
Name:TUCKER, WILLIAM ELLIS (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ELLIS
Last Name:TUCKER
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 1:4600 MONTGOMERY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5108 SANDY LN
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2738
Practice Address - Country:US
Practice Address - Phone:833-510-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54491207P00000X
TXR4489207P00000X
NY60169114207P00000X
CAG-00063490207P00000X
FLME133220207P00000X
KY49303207P00000X
MO2016022007207P00000X
NC00061207P00000X
PAMD054415L207P00000X
SCMD40001207P00000X
OH35061655207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000317866OtherBCBS
OH000000380633OtherANTHEM/BCBS
OH0826324Medicaid
OH000000377119OtherANTHEM/BCBS
OH0848855Medicare PIN
OH0826324Medicaid
000000317866OtherBCBS
OH0848854Medicare PIN