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NPI Code Detail

MEDICARE: TRAVIS TANNER

MEDICARE: TRAVIS TANNER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1265371363
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRAVIS TANNER
Provider Business Mailing Address
First Line : 1412 N CENTER ST APT 1
Second Line :
City : MESA
State : AZ
Zip : 85201-2607
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2000 W BETHANY HOME RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85015-2443
Country : US
Telephone Number : 602-249-0212
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/25/2026
Last Update Date : 03/26/2026

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Directions to “ TRAVIS TANNER ” Practice Location

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