Individual
BENJAMIN D TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 DUPONT RD, LOUISVILLE, KY 40207-4611
(502) 889-6405
(502) 899-6407
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
33097
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000642238
ANTHEM - NHWMS
KY
01
—
000052153C
HUMANA - NHWMS
KY
01
—
110964
SIHO - NHWMS
KY
05
—
200518160
—
IN
01
—
3764333000
PASSPORT ADVANTAGE - NHWMS
KY
01
—
3945283
CIGNA - NHWMS
KY
01
—
50006995
PASSPORT
KY
01
—
50027318
PASSPORT - NHWMS
KY
05
—
64100811
—
KY
Enumeration date
01/24/2006
Last updated
01/22/2021
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