Provider Demographics
NPI:1659521888
Name:J. ROSS TANNER, D.O. LLC
Entity Type:Organization
Organization Name:J. ROSS TANNER, D.O. LLC
Other - Org Name:DIABETES AND LIPID CLINIC OF ALASKA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:WILLIAM RAY
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-274-7844
Mailing Address - Street 1:2841 DEBARR RD
Mailing Address - Street 2:SUITE 43
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2932
Mailing Address - Country:US
Mailing Address - Phone:907-274-7844
Mailing Address - Fax:907-274-7845
Practice Address - Street 1:2841 DEBARR RD
Practice Address - Street 2:SUITE 43
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2932
Practice Address - Country:US
Practice Address - Phone:907-274-7844
Practice Address - Fax:907-274-7845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5561207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty