Provider Demographics
NPI:1205175338
Name:TANNER, JEREMY A (MD, MPH)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:A
Last Name:TANNER
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7703 FLOYD CURL DRIVE, MC 7883
Mailing Address - Street 2:PARC BUILDING ROOM 417
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-8834
Mailing Address - Fax:
Practice Address - Street 1:7703 FLOYD CURL DR # MC8070
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3901
Practice Address - Country:US
Practice Address - Phone:210-450-9960
Practice Address - Fax:210-450-2139
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXU08602084N0400X, 2084B0040X
CAA1533992084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084B0040XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyBehavioral Neurology & Neuropsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology