Provider Demographics
NPI:1639289507
Name:TANKSON, CEDRIC J (MD)
Entity Type:Individual
Prefix:DR
First Name:CEDRIC
Middle Name:J
Last Name:TANKSON
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 1:701 MEDICAL PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-7313
Mailing Address - Country:US
Mailing Address - Phone:352-326-8115
Mailing Address - Fax:352-326-4186
Practice Address - Street 1:701 MEDICAL PLAZA DR
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-7313
Practice Address - Country:US
Practice Address - Phone:352-326-8115
Practice Address - Fax:352-326-4186
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93733207XX0004X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30061OtherBLUE CROSS OF FL
FL105136300Medicaid
FL30061OtherBLUE CROSS OF FL