Individual
JUSTIN J TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
2350
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
48484
STATE LICENSE
CO
Enumeration date
06/22/2007
Last updated
11/25/2024
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