Healthcare Provider Details

I. General information

NPI: 1205175338
Provider Name (Legal Business Name): JEREMY A TANNER MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR # MC8070
SAN ANTONIO TX
78229-3901
US

IV. Provider business mailing address

7703 FLOYD CURL DRIVE, MC 7883 PARC BUILDING ROOM 417
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9960
  • Fax: 210-450-2139
Mailing address:
  • Phone: 210-450-8834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberU0860
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA153399
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License NumberU0860
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: