Individual
MR. JASON TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
12911 E 21ST ST N, WICHITA, KS 67230-7408
(316) 630-8420
Mailing address
12911 E 21ST ST N, WICHITA, KS 67230-7408
(316) 630-8420
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
—
—
224P00000X
Prosthetist
—
—
Other
Enumeration date
02/14/2023
Last updated
02/14/2023
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