Individual
J LANE TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
747 52ND ST, CHRCO CHILD DEVELOPMENT CENTER, OAKLAND, CA 94609-1809
(510) 428-3351
(510) 601-3912
Mailing address
747 52ND ST, CHRCO CHILD DEVELOPMENT CENTER, OAKLAND, CA 94609-1809
(510) 428-3351
(510) 601-3912
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
G28611
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0095850
—
CA
Enumeration date
11/30/2006
Last updated
07/08/2007
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