Provider Demographics
NPI:1851360150
Name:TANABE, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:TANABE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4451
Mailing Address - Fax:970-490-4199
Practice Address - Street 1:5955 LEHMAN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3420
Practice Address - Country:US
Practice Address - Phone:719-522-1133
Practice Address - Fax:719-264-1772
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2018-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO27632207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01276328Medicaid
X7318Medicare ID - Type Unspecified
D24974Medicare UPIN