Healthcare Provider Details

I. General information

NPI: 1942284096
Provider Name (Legal Business Name): CARY TANNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 07/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 E HERNDON AVE
FRESNO CA
93720-3305
US

IV. Provider business mailing address

1630 E HERNDON AVE
FRESNO CA
93720-3305
US

V. Phone/Fax

Practice location:
  • Phone: 559-256-5200
  • Fax: 559-256-5376
Mailing address:
  • Phone: 559-256-5200
  • Fax: 559-256-5376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG52071
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: