Individual
TANNER NICHOLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2710 S RIFE MEDICAL LN, ROGERS, AR 72758-1452
(870) 897-5840
Mailing address
522 S HUNT CLUB BLVD # 413, APOPKA, FL 32703-4960
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
26319
MS
2085R0202X
Diagnostic Radiology Physician
Primary
4643
TN
2085R0202X
Diagnostic Radiology Physician
E-13773
AR
Other
Enumeration date
04/29/2017
Last updated
06/19/2023
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