MEDICARE: CLINT STEVEN TANNER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD-2013-0763	NM
2	2084P0800X	Psychiatry Physician	#DR.0054779	CO

General Provider Information

NPI Number	:	1336439801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLINT STEVEN TANNER M.D.

Provider Business Mailing Address
First Line	:	13780 E RICE PL STE 103
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-1257
Country	:	US
Telephone Number	:	720-575-5400
Fax Number	:	720-709-1161

Provider Business Practice Location Address
First Line	:	13780 E RICE PL STE 103
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80015-1257
Country	:	US
Telephone Number	:	720-575-5400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2011
Last Update Date	:	08/03/2020

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