Dale Tucker, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME76518 Issued in FL

Practice address

1506 Alice St
Waycross, GA 31501-4531

Phone

(912) 584-6500

NPI assigned

Jun 21, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in FL, GA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dale.tucker.1@9582.direct.athenahealth.com
• Direct secure messaging: dale.tucker.1@8967.direct.athenahealth.com
• Direct secure messaging: dale.tucker.3@8967.direct.athenahealth.com
• Direct secure messaging: dale.tucker.2@8967.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St Vincent'S Full Service Urgent Care, LLC

  • Occupational Medicine Clinic/Center
  • Jacksonville, FL
  • NPI 1750672051

  GA

  Medicare reassignment NPD
• St Vincents Ambulatory Care Inc

  • Neurological Surgery Physician
  • Jacksonville, FL
  • NPI 1417987124

  GA

  Medicare reassignment NPD
• Vincent Galiano M D P a

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1750499380
  Medicare reassignment NPD
• St Vincents Ambulatory Care Inc

  • Durable Medical Equipment & Medical Supplies
  • Jacksonville, FL
  • NPI 1679226690
  NPD
• Emergency Medicine South LLC

  • Emergency Medicine Physician
  • Valdosta, GA
  • NPI 1194785170
  NPD (past)
• Emergency Medical Specialists of Jacksonville

  • Emergency Medicine Physician
  • Jacksonville, FL
  • NPI 1295738367
  NPD (past)
• Florida Multi Specialty Medical Group, PA

  • Physical Medicine & Rehabilitation Physician
  • Jacksonville, FL
  • NPI 1356497572
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714608000000",
    "number": "1720024425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4205 BELFORT RD STE 4015",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322163623",
            "telephone_number": "904-346-5426",
            "fax_number": "904-346-0113"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1506 ALICE ST",
            "city": "WAYCROSS",
            "state": "GA",
            "postal_code": "315014531",
            "telephone_number": "912-584-6500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10503 San Jose Blvd",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322576295",
            "country_code": "US",
            "telephone_number": "904-450-6700",
            "fax_number": "904-450-6691",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "DALE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2024-05-02",
        "certification_date": "2024-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "FL",
            "license": "ME76518",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "48092",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME76518",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "930119999",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "35915",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261605000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Towns, LPC
• Trimed Advance Health, LLC
• Brian Trissell, MD
• Lucinda Trotter, RN
• Trumbalt Dynamics LLC
• Robert W Tucker, PA
• Lauren Carden Turner
• Tiffany Denise Tyler
• Kennon Latrell Tyre III, PHARM.D.
• Mitzi Braddock Tyre, FNP

• Family Medicine Physician in Waycross, GA
• Providers in Waycross, GA by specialty
• Family Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.