Tucker, Gary Jackson

Tucker, Gary Jackson is an individual health care provider with primary practice located at 418 Colegate Dr , Marietta OH 45750-9549. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Tucker, Gary Jackson can be contacted via phone (740) 568-0412.

Contact Information

Primary practice address
418 Colegate Dr Marietta OH 45750-9549
Phone: (740) 568-0412
Fax: (740) 568-0413
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 18392 West Virginia
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 35.098674 Ohio

Profile Details

NPI number 1154398493
LBN Legal business name Tucker, Gary Jackson
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 7th, 2006
Last updated Feb 20th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154398493 NPPES
Ohio MEDICAID 0193633
Ohio MEDICAID 0054604000
Ohio Other P01036081

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