Provider Demographics
NPI:1164502910
Name:TANNER, CURTIS WINDER (PA-C/SA)
Entity Type:Individual
Prefix:MR
First Name:CURTIS
Middle Name:WINDER
Last Name:TANNER
Suffix:
Gender:M
Credentials:PA-C/SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:434 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:KERMAN
Mailing Address - State:CA
Mailing Address - Zip Code:93630-1570
Mailing Address - Country:US
Mailing Address - Phone:559-846-4209
Mailing Address - Fax:559-846-4205
Practice Address - Street 1:1210 E ALMOND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5606
Practice Address - Country:US
Practice Address - Phone:559-675-5530
Practice Address - Fax:559-675-5532
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA #12626363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA550989Medicare UPIN
CAOPA12260Medicare ID - Type UnspecifiedPROVIDER #