Individual
DR. TANNER LAYNE MATTISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2609 SIR GAWAIN LN, LEWISVILLE, TX 75056-5719
(214) 392-5871
Mailing address
2609 SIR GAWAIN LN, LEWISVILLE, TX 75056-5719
(214) 392-5871
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
L2451
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2008-02044
—
NC
05
—
42717
—
AZ
05
—
49732-1
—
NY
05
—
DR.0049728
—
CO
05
—
L2451
—
TX
05
—
MD.202224
—
LA
05
—
MD2008-0818
—
NM
Enumeration date
04/07/2006
Last updated
04/03/2024
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