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Individual
KEVIN SCOTT TANNER
Active
Individual
KEVIN SCOTT TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
00676
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10373
WELLMARK PROVIDER NUMBER
IA
05
—
1172692
—
IA
Enumeration date
10/20/2005
Last updated
03/12/2008
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