Provider Demographics
NPI:1013959279
Name:TANNE, EMANUEL (MD)
Entity type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:TANNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6517 BUENA VISTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661
Mailing Address - Country:US
Mailing Address - Phone:360-694-4777
Mailing Address - Fax:360-694-7062
Practice Address - Street 1:6517 BUENA VISTA DRIVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661
Practice Address - Country:US
Practice Address - Phone:360-694-4777
Practice Address - Fax:360-694-7062
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA13092207W00000X
CAG8840207W00000X
ORMD08581207W00000X
AZ7514207W00000X
NJ25MA02104100207W00000X
MOR4176207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1861509Medicaid
A08088Medicare UPIN
WA1861509Medicaid