Healthcare Provider Details

I. General information

NPI: 1679501456
Provider Name (Legal Business Name): ANDREW SCOTT TANNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE SUITE CC-101
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

PO BOX 800022
KANSAS CITY MO
64180-0022
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5281
  • Fax: 719-776-2525
Mailing address:
  • Phone: 800-953-0104
  • Fax: 303-765-6670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number44693
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: