Individual
DR. GUILLERMO JAVIER TANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M. D.
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(877) 406-2916
(601) 682-7909
Mailing address
PO BOX 55769, JACKSON, MS 39296-5769
(601) 200-6162
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
022779
LA
2085R0202X
Diagnostic Radiology Physician
Primary
16799
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00122175
—
MS
01
—
1861428351
GROUP MEDICARE NPI
—
01
—
C00475
GROUP MEDICARE UPIN
—
Enumeration date
07/29/2006
Last updated
11/08/2023
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