Individual
BRANDON MICHEAL TANNER
Active
Individual
BRANDON MICHEAL TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01083292A
IN
208600000X
Surgery Physician
4301109615
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301109615
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1043692478
ANTHEM PTAN
IN
01
—
1102614356
ANTHEM PTAN
IN
05
—
300014111
—
IN
Enumeration date
06/22/2015
Last updated
11/25/2024
Update your record
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