Provider Demographics
NPI:1518426394
Name:PIMSAKUL, TANNER (MD)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:PIMSAKUL
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 1:2031 N. BUFFALO DR.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128
Mailing Address - Country:US
Mailing Address - Phone:702-383-2650
Mailing Address - Fax:702-256-2213
Practice Address - Street 1:2031 N. BUFFALO DR.
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128
Practice Address - Country:US
Practice Address - Phone:702-383-2650
Practice Address - Fax:702-256-2213
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22509207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine