Provider Demographics
NPI:1770793812
Name:CAVERLY, TANNER (MD)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:CAVERLY
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:UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
Mailing Address - Street 2:4200 E 9TH AVE., B177
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80262-0001
Mailing Address - Country:US
Mailing Address - Phone:303-315-7424
Mailing Address - Fax:
Practice Address - Street 1:UNIVERSITY OF COLORADO SCHOOL OF MEDICINE
Practice Address - Street 2:4200 E 9TH AVE., B177
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80262-0001
Practice Address - Country:US
Practice Address - Phone:303-315-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine