Provider Demographics
NPI:1730273806
Name:TUCKER, WILLIAM M (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:M
Last Name:TUCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4000 MEDICAL CENTER DR STE 207
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6631
Mailing Address - Country:US
Mailing Address - Phone:315-637-1010
Mailing Address - Fax:
Practice Address - Street 1:4000 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 207
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6631
Practice Address - Country:US
Practice Address - Phone:315-637-1010
Practice Address - Fax:315-637-2010
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY151001207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C59449Medicare UPIN
BA0676Medicare ID - Type Unspecified