Provider Demographics
NPI:1073581385
Name:TENNANT, GREGORY (DO)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:TENNANT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42135 10TH ST W STE 101
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7099
Mailing Address - Country:US
Mailing Address - Phone:661-726-5005
Mailing Address - Fax:661-726-5377
Practice Address - Street 1:42135 10TH ST W STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7099
Practice Address - Country:US
Practice Address - Phone:661-726-5005
Practice Address - Fax:661-726-5377
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9121207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH93526Medicare UPIN