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NPI Code Detail

MEDICARE: MR. TANNER TOD THORNTON PA-C

MEDICARE: MR. TANNER TOD THORNTON PA-C
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
1363A00000XPhysician Assistant8056AZ

General Provider Information

NPI Number : 1972121036
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. TANNER TOD THORNTON PA-C
Provider Business Mailing Address
First Line : 20280 N 59TH AVE STE 115-617
Second Line :
City : GLENDALE
State : AZ
Zip : 85308-6850
Country : US
Telephone Number : 602-795-8710
Fax Number : 602-795-8701
Provider Business Practice Location Address
First Line : 725 S DOBSON RD STE 100
Second Line :
City : CHANDLER
State : AZ
Zip : 85224-5676
Country : US
Telephone Number : 602-795-8700
Fax Number : 602-795-8701
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2020
Last Update Date : 10/16/2020

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