Individual
MR. DOUGLAS EVAN TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
210 E MAIN ST, SPRINGVILLE, NY 14141-1442
(716) 592-3635
Mailing address
210 E MAIN ST, SPRINGVILLE, NY 14141-1442
(716) 592-3635
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
005527-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00026501103
UNIVERA
NY
01
—
0003153
GHI
NY
01
—
000570091007
BCBS
NY
05
—
01666426
—
NY
01
—
9514284AOA
INDEPENDENT HEALTH
NY
01
—
P00459731
RRMEDICARE
NY
Enumeration date
06/16/2006
Last updated
04/14/2008
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