Healthcare Provider Details

I. General information

NPI: 1447547385
Provider Name (Legal Business Name): JASON F. TANNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2011
Last Update Date: 09/11/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 SE GREENVILLE AVE
WINCHESTER IN
47394-9436
US

IV. Provider business mailing address

5440 SENTINEL OAK DR
MASON OH
45040-7691
US

V. Phone/Fax

Practice location:
  • Phone: 765-584-0004
  • Fax: 765-584-0066
Mailing address:
  • Phone: 260-667-8913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.132469
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01072923A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.132469
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51681
License Number StateKY
# 5
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number01072923A
License Number StateIN
# 6
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number51681
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: