Provider Demographics
NPI:1760804827
Name:BARRY TANNE, M.D.
Entity Type:Organization
Organization Name:BARRY TANNE, M.D.
Other - Org Name:GRANITE FALLS MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TANNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-691-7711
Mailing Address - Street 1:P.O. BOX 1650
Mailing Address - Street 2:
Mailing Address - City:GRANITE FALLS
Mailing Address - State:WA
Mailing Address - Zip Code:98252
Mailing Address - Country:US
Mailing Address - Phone:360-691-7711
Mailing Address - Fax:360-691-7864
Practice Address - Street 1:403 SOUTH GRANITE AVE
Practice Address - Street 2:
Practice Address - City:GRANITE FALLS
Practice Address - State:WA
Practice Address - Zip Code:98252
Practice Address - Country:US
Practice Address - Phone:360-691-7711
Practice Address - Fax:360-691-7864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-09
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017729207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty