Provider Demographics
NPI:1750684676
Name:GREGORY C. TANNER, M.D. P.C.
Entity Type:Organization
Organization Name:GREGORY C. TANNER, M.D. P.C.
Other - Org Name:ALTA VIEW OBGYN
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-572-0124
Mailing Address - Street 1:9600 S 1300 E STE 305
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3767
Mailing Address - Country:US
Mailing Address - Phone:801-572-0124
Mailing Address - Fax:866-815-0634
Practice Address - Street 1:9600 S 1300 E STE 305
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3767
Practice Address - Country:US
Practice Address - Phone:801-572-0124
Practice Address - Fax:866-815-0634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT157109-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528661529000Medicaid
UT000004991Medicare Oscar/Certification