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General NPI Number Information
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NPI Number | 1306424692
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Entity Type | Individual
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Provider Name | TANNER CROSHAW PA
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Gender | Male
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Dates
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Enumeration Date | 03/30/2021
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 3970 W ANN RD STE 100
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-3853
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Country | US
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Telephone | 702-747-4799
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Fax | 702-747-4667
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Provider Business Mailing Address
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Address Line | 3970 W ANN RD STE 100
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89031-3853
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Country | US
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Telephone | 702-747-4799
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Fax | 702-747-4667
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 1179657
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License Number State | NV
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