Provider Demographics
NPI:1912182635
Name:TANNER, DIRK (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DIRK
Middle Name:
Last Name:TANNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 TUDOR CENTRE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5904
Mailing Address - Country:US
Mailing Address - Phone:907-729-8624
Mailing Address - Fax:
Practice Address - Street 1:4201 TUDOR CENTRE DR
Practice Address - Street 2:SUITE 320
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5904
Practice Address - Country:US
Practice Address - Phone:907-729-8624
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant