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NPI Code Detail

MEDICARE: JEFFREY TANITA M.D.

MEDICARE: JEFFREY TANITA M.D.
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
1207Q00000XFamily Medicine Physician200484LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922040443
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY TANITA M.D.
Provider Business Mailing Address
First Line : 1136A N PINE RD
Second Line :
City : OLLA
State : LA
Zip : 71465-4804
Country : US
Telephone Number : 318-495-3880
Fax Number : 318-495-3882
Provider Business Practice Location Address
First Line : 1136A N PINE RD
Second Line :
City : OLLA
State : LA
Zip : 71465-4804
Country : US
Telephone Number : 318-495-3880
Fax Number : 318-495-3882
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2006
Last Update Date : 09/22/2014

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Directions to “ JEFFREY TANITA M.D.” Practice Location

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