Individual
JEFFREY P TANNENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
430 LIBERTY ST, SUITE 7, HANSON, MA 02341-1113
(781) 293-3838
(781) 293-3639
Mailing address
680 CENTRE ST, BROCKTON, MA 02302-3308
(508) 941-7000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
77474
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3119572
—
MA
Enumeration date
09/21/2005
Last updated
09/18/2018
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