Provider Demographics
NPI:1245597095
Name:BARLOW, TANNER JOHN (LMP)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:JOHN
Last Name:BARLOW
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 C ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98663-3400
Mailing Address - Country:US
Mailing Address - Phone:360-694-0300
Mailing Address - Fax:
Practice Address - Street 1:1610 C ST
Practice Address - Street 2:SUITE 103
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3400
Practice Address - Country:US
Practice Address - Phone:360-694-0300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-18
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty