Provider Demographics
NPI:1578629960
Name:TANQUARY, JOHN FRANK (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FRANK
Last Name:TANQUARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:327 W FAYETTE ST
Mailing Address - Street 2:RM 312
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-1275
Mailing Address - Country:US
Mailing Address - Phone:315-422-7699
Mailing Address - Fax:315-478-7655
Practice Address - Street 1:327 W FAYETTE ST
Practice Address - Street 2:RM 312
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-1275
Practice Address - Country:US
Practice Address - Phone:315-422-7699
Practice Address - Fax:315-478-7655
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1703192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56247BMedicare ID - Type Unspecified