Healthcare Provider Details

I. General information

NPI: 1144924978
Provider Name (Legal Business Name): TANNER LUKE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N 500 W
PROVO UT
84604-3305
US

IV. Provider business mailing address

8500 W 110TH ST STE 260
OVERLAND PARK KS
66210-1892
US

V. Phone/Fax

Practice location:
  • Phone: 877-674-1211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number14237929-0501
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: