Provider Demographics
NPI:1700237161
Name:CROSSLEY, TANNER (DO)
Entity Type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:CROSSLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6582 165TH ST
Mailing Address - Street 2:
Mailing Address - City:ALBIA
Mailing Address - State:IA
Mailing Address - Zip Code:52531-8793
Mailing Address - Country:US
Mailing Address - Phone:641-932-7172
Mailing Address - Fax:641-932-7172
Practice Address - Street 1:6582 156TH STREET
Practice Address - Street 2:
Practice Address - City:ALBIA
Practice Address - State:IA
Practice Address - Zip Code:52531
Practice Address - Country:US
Practice Address - Phone:641-932-7172
Practice Address - Fax:641-932-7172
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT017422390200000X
IA05380207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program