Provider Demographics
NPI:1760607428
Name:TANNER, PAUL BENJAMIN (MBA, CCA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BENJAMIN
Last Name:TANNER
Suffix:
Gender:M
Credentials:MBA, CCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3474 S 100 E
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84010-6605
Mailing Address - Country:US
Mailing Address - Phone:801-997-0545
Mailing Address - Fax:888-977-5399
Practice Address - Street 1:1455 S 500 W STE D
Practice Address - Street 2:
Practice Address - City:BOUNTIFUL
Practice Address - State:UT
Practice Address - Zip Code:84010-8252
Practice Address - Country:US
Practice Address - Phone:801-997-0545
Practice Address - Fax:888-977-5399
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologist
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical