Provider Demographics
NPI:1245509652
Name:DAVID J TANZER MD INC A PROFESSIONAL CORPORATIO
Entity type:Organization
Organization Name:DAVID J TANZER MD INC A PROFESSIONAL CORPORATIO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:TANZER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-767-2555
Mailing Address - Street 1:4910 DIRECTORS PL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3811
Mailing Address - Country:US
Mailing Address - Phone:855-767-2555
Mailing Address - Fax:855-767-2556
Practice Address - Street 1:4910 DIRECTORS PL
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3811
Practice Address - Country:US
Practice Address - Phone:855-767-2555
Practice Address - Fax:855-767-2556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty