Myra Beth Tuckerman, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

45139 Issued in CO

Practice address

1790 30TH St
Suite 308
Boulder, CO 80301-1022

Phone

(303) 440-0205

Fax

(303) 440-0209

NPI assigned

Sep 12, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218758400000",
    "number": "1831184381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1790 30TH ST.",
            "address_2": "SUITE 308",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "80301",
            "telephone_number": "303-440-0205",
            "fax_number": "303-440-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1790 30TH ST",
            "address_2": "SUITE 308",
            "city": "BOULDER",
            "state": "CO",
            "postal_code": "803011022",
            "telephone_number": "303-440-0205",
            "fax_number": "303-440-0209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKERMAN",
        "first_name": "MYRA",
        "middle_name": "BETH",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-12",
        "last_updated": "2008-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "45139",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0191671",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080188923",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Julie Tu
• Linda Tuber, M.S.W.
• Chandler Tucker
• Ellen Wall Tucker, LCSW
• Kathryn Tucker
• Grace Tulley
• Ellen Tuohy
• Christopher Miles Turf, RPH
• Jennifer Turf, RPH
• Margaret Turnbull

• Family Medicine Physician in Boulder, CO
• Providers in Boulder, CO by specialty
• Family Medicine Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; 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.