Provider Demographics
NPI:1871770990
Name:DONALD S TANNER DPM PA
Entity type:Organization
Organization Name:DONALD S TANNER DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:TANNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-722-1000
Mailing Address - Street 1:7421 N.. UNIVERSITY DR.
Mailing Address - Street 2:STE 204
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2953
Mailing Address - Country:US
Mailing Address - Phone:954-722-1000
Mailing Address - Fax:954-721-7333
Practice Address - Street 1:7421 N. UNIVERSITY DR.
Practice Address - Street 2:STE 204
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2953
Practice Address - Country:US
Practice Address - Phone:954-722-1000
Practice Address - Fax:954-721-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-31
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO729332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT55406Medicare UPIN
FL0631350001Medicare NSC