Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 38635 | CO |
NPI | 1609897578 |
---|---|
Provider Name | David Eric Tanner |
First Address | Boulder, CO 80303-4284 |
Second Address | Boulder, CO 80303-4284 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 06/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H32430 | (02) | CO |