Provider Demographics
NPI:1427277888
Name:TUCKER, SPENCER PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:PAUL
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 1:12163 E ADAMS RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2103
Mailing Address - Country:US
Mailing Address - Phone:225-294-0532
Mailing Address - Fax:225-294-0532
Practice Address - Street 1:12163 E ADAMS RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2103
Practice Address - Country:US
Practice Address - Phone:225-294-0532
Practice Address - Fax:225-294-0532
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA202239208600000X
LAMD.202239207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309834Medicaid
LA1309834Medicaid
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