Provider Demographics
NPI:1396031233
Name:TANIS, JAMES FRANCIS JR (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FRANCIS
Last Name:TANIS
Suffix:JR
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 1:19806 EAGLE RUN
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:FL
Mailing Address - Zip Code:34736-8450
Mailing Address - Country:US
Mailing Address - Phone:407-714-8490
Mailing Address - Fax:
Practice Address - Street 1:19806 EAGLE RUN
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:FL
Practice Address - Zip Code:34736-8450
Practice Address - Country:US
Practice Address - Phone:077-148-4904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09967000207P00000X
PAMT199876390200000X
FLME137079207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program