Individual
KATHRYN E TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938-4644
(661) 334-0203
Mailing address
3 TEALWOOD CV, CHARLESTON, IL 61920-4407
(956) 357-4082
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
2001006985
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
205247208
—
MO
Enumeration date
05/17/2006
Last updated
03/07/2023
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