Provider Demographics
NPI:1407476518
Name:CABBAGE, TANNER DOUGLAS (DO)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:DOUGLAS
Last Name:CABBAGE
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 1:853 JEFFERSON AVE # E201
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:853 JEFFERSON AVENUE E201
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38163-1405
Practice Address - Country:US
Practice Address - Phone:901-448-1078
Practice Address - Fax:901-287-5062
Is Sole Proprietor?:No
Enumeration Date:2020-04-18
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program