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Individual
BRANDON DEE TANNER
Active
Individual
BRANDON DEE TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1058
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
289207701
—
TX
01
—
865N24
BCBS TEXAS
TX
Enumeration date
10/24/2011
Last updated
03/17/2021
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