Individual
JONATHAN W TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3400 SPRUCE STREET, 6 DULLES BUILDING, PHILADELPHIA, PA 19104
(215) 349-8310
Mailing address
3400 SPRUCE STREET, 6 DULLES, PHILADELPHIA, PA 19104
(215) 349-8310
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD059340L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0016138200001
—
PA
Enumeration date
06/14/2006
Last updated
09/11/2014
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