Basic Information
| Provider Information | |||||||||
| NPI: | 1124029178 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TUCKER | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | BARRY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 BOWER HILL RD | ||||||||
| Address2: | AFFILIATE BILLING | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4129422533 | ||||||||
| FaxNumber: | 4129422589 | ||||||||
| Practice Location | |||||||||
| Address1: | 1082 BOWER HILL RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152431324 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122760267 | ||||||||
| FaxNumber: | 4122767215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2005 | ||||||||
| LastUpdateDate: | 12/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD034772E | PA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0012291940005 | 05 | PA | MEDICAID |