MEDICARE: GREGORY C 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	207VG0400X	Gynecology Physician	157109-1205	UT

General Provider Information

NPI Number	:	1598875973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY C TANNER M.D.

Provider Business Mailing Address
First Line	:	41 NORTHRIDGE WAY
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84092-4906
Country	:	US
Telephone Number	:	801-963-1880
Fax Number	:	801-963-1886

Provider Business Practice Location Address
First Line	:	9600 S 1300 E
Second Line	:	STE 305
City	:	SANDY
State	:	UT
Zip	:	84094-3766
Country	:	US
Telephone Number	:	801-963-1880
Fax Number	:	801-963-1886

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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