Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 0101047618 | VA |
NPI | 1548367667 |
---|---|
Provider Name | Dr. Rebecca Webb Tanner |
First Address | Roanoke, VA 24014-5144 |
Second Address | Roanoke, VA 24014-5144 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6801510 | (05) | VA |
F67749 | (02) | VA |