Provider Demographics
NPI:1356361950
Name:TANAKA, JOEL TRAVIS (MD)
Entity type:Individual
Prefix:DR
First Name:JOEL
Middle Name:TRAVIS
Last Name:TANAKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:EVANS ARMY COMMUNITY HOSPITAL (EACH) USA MEDDAC
Mailing Address - Street 2:1650 COCHRANE CIRCLE ATTN: CREDENTIALS OFFICE
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4604
Mailing Address - Country:US
Mailing Address - Phone:719-526-7844
Mailing Address - Fax:719-526-7984
Practice Address - Street 1:ROBINSON FAMILY MEDICINE CLINIC (TMC10)
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4604
Practice Address - Country:US
Practice Address - Phone:719-524-2207
Practice Address - Fax:719-524-2258
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9800712207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine