Provider Demographics
NPI:1578756573
Name:TANEY, GARY (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:TANEY
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 1:910 SW 1093 PRIVATE ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:MO
Mailing Address - Zip Code:64770
Mailing Address - Country:US
Mailing Address - Phone:660-492-7656
Mailing Address - Fax:
Practice Address - Street 1:910 SW 1093 PRIVATE ROAD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:MO
Practice Address - Zip Code:64770
Practice Address - Country:US
Practice Address - Phone:660-492-7656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5125207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1555001OtherMEDICARE NUMBER
MOC50304Medicare UPIN