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Individual

KEVIN SCOTT TANNER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.P.M.

Contact information

Practice address
3359 CENTER POINT RD NE, CEDAR RAPIDS, IA 52402-5568
(319) 393-4343
(319) 393-4464
Mailing address
3359 CENTER POINT RD NE, CEDAR RAPIDS, IA 52402-5568
(319) 393-4343
(319) 393-4464

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
00676
IA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10373
WELLMARK PROVIDER NUMBER
IA
05
1172692
IA
Enumeration date
10/20/2005
Last updated
03/12/2008
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