Individual
TANNER WALLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
12255 DEPAUL DRIVE, SUITE 500, SAINT LOUIS, MO 63044
(314) 209-5180
Mailing address
12255 DEPAUL DRIVE, SUITE 500, SAINT LOUIS, MO 63040
(314) 209-5180
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2020024367
MO
207RP1001X
Pulmonary Disease Physician
Primary
2020024367
MO
Other
Enumeration date
07/01/2017
Last updated
07/01/2026
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