Provider Demographics
NPI:1609871367
Name:TANNER, DONALD STEPHEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:STEPHEN
Last Name:TANNER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 N UNIVERSITY DR
Mailing Address - Street 2:STE 204
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2953
Mailing Address - Country:US
Mailing Address - Phone:954-722-1000
Mailing Address - Fax:954-721-7333
Practice Address - Street 1:7421 N UNIVERSITY DR
Practice Address - Street 2:STE 204
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2953
Practice Address - Country:US
Practice Address - Phone:954-722-1000
Practice Address - Fax:954-721-7333
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 729213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T55406Medicare UPIN
87298Medicare ID - Type Unspecified