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NPI Code Detail

MEDICARE: DR. REBECCA WEBB TANNER

MEDICARE: DR. REBECCA WEBB 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
1204C00000XSports Medicine (Neuromusculoskeletal Medicine) Physician0101047618VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1548367667
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. REBECCA WEBB TANNER
Provider Business Mailing Address
First Line : 4582 FRANKLIN RD SW
Second Line :
City : ROANOKE
State : VA
Zip : 24014-5144
Country : US
Telephone Number : 540-772-8052
Fax Number : 540-772-4508
Provider Business Practice Location Address
First Line : 4582 FRANKLIN RD SW
Second Line :
City : ROANOKE
State : VA
Zip : 24014-5144
Country : US
Telephone Number : 540-772-8052
Fax Number : 540-772-4508
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 07/09/2007

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Directions to “ DR. REBECCA WEBB TANNER ” Practice Location

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