Healthcare Provider Details

I. General information

NPI: 1770793812
Provider Name (Legal Business Name): TANNER CAVERLY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIVERSITY OF COLORADO SCHOOL OF MEDICINE 4200 E 9TH AVE., B177
DENVER CO
80262-0001
US

IV. Provider business mailing address

UNIVERSITY OF COLORADO SCHOOL OF MEDICINE 4200 E 9TH AVE., B177
DENVER CO
80262-0001
US

V. Phone/Fax

Practice location:
  • Phone: 303-315-7424
  • Fax:
Mailing address:
  • Phone: 303-315-7424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2322
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: