Healthcare Provider Details

I. General information

NPI: 1487805909
Provider Name (Legal Business Name): LEIGH H TANNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 10/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE DEPARTMENT OF ANESTHESIOLOGY - STE 301 (CENTRAL BLDG)
MIAMI FL
33136-1005
US

IV. Provider business mailing address

7900 HARBOR ISLAND DR APT 805
NORTH BAY VILLAGE FL
33141-4281
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-6973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberTRN11368
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: