Healthcare Provider Details

I. General information

NPI: 1609871367
Provider Name (Legal Business Name): DONALD STEPHEN TANNER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7421 N UNIVERSITY DR STE 204
TAMARAC FL
33321-2953
US

IV. Provider business mailing address

7421 N UNIVERSITY DR STE 204
TAMARAC FL
33321-2953
US

V. Phone/Fax

Practice location:
  • Phone: 954-722-1000
  • Fax: 954-721-7333
Mailing address:
  • Phone: 954-722-1000
  • Fax: 954-721-7333

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO 729
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: