Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 01079665A | IN |
NPI | 1235404526 |
---|---|
Provider Name | Dr. Eric Philip Tannenbaum |
First Address | Columbus, IN 47201-2610 |
Second Address | Columbus, IN 47201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2012 |
Last Update Date | 09/08/2018 |