Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | D0065957 | MD |
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | D0065957 | MD |
N | 2081S0010X | Sports Medicine | D0065957 | MD |
N | 213ES0000X | Sports Medicine | D0065957 | MD |
NPI | 1902028939 |
---|---|
Provider Name | Frank Javier Tanon |
First Address | Baltimore, MD 21215-5216 |
Second Address | Baltimore, MD 21215-5228 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
013689100 | (05) | MD |