Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | 036147391 | IL |
N | 207VX0201X | Gynecologic Oncologist | 247219 | NY |
N | 207VX0201X | Gynecologic Oncologist | D74316 | MD |
NPI | 1013059781 |
---|---|
Provider Name | Dr. Edward James Tanner III |
First Address | Chicago, IL 60611-2914 |
Second Address | Chicago, IL 60611-2914 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2007 |
Last Update Date | 25/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056633100 | (05) | MD |
P19171 | (02) | MD |