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Individual
DAVID E TANNER
Active
Individual
DAVID E TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
OSOO4411L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005986020003
—
PA
01
—
01014602
CAPITAL BLUE CROSS
PA
01
—
080031059
PALMETTA GBA
PW
01
—
TA148070
HIGHMARK BLUE SHIELD
PA
Enumeration date
04/14/2006
Last updated
06/28/2010
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