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General NPI Number Information
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NPI Number | 1588396964
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Entity Type | Individual
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Provider Name | BRADLEY TANNER PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/25/2022
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 1637 E MONUMENT PLAZA CIR STE 1
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City | CASA GRANDE
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State | AZ
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Zip | 85122-5639
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Country | US
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Telephone | 520-426-1512
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Fax | 520-509-3728
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Provider Business Mailing Address
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Address Line | 2608 N BARKLEY
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City | MESA
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State | AZ
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Zip | 85203-1204
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Country | US
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Telephone |
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9551
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License Number State | AZ
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