Provider Demographics
NPI:1407896434
Name:TANZER, RICHARD (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:TANZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7985 SANTA MONICA BLVD.
Mailing Address - Street 2:#109-13
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046
Mailing Address - Country:US
Mailing Address - Phone:323-650-3969
Mailing Address - Fax:818-788-0386
Practice Address - Street 1:FAMILY URGENT CARE & INDUTRIAL MEDICAL CLINIC
Practice Address - Street 2:15450 VENTURA BLVD. STE. 102
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-808-2828
Practice Address - Fax:818-788-0386
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine