Basic Information
| Provider Information | |||||||||
| NPI: | 1982059671 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TANNER | ||||||||
| FirstName: | THOMAS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 904 W 25TH ST UNIT B | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770082383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547235036 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6621 FANNIN ST STE A210 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770302358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7137985928 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2016 | ||||||||
| LastUpdateDate: | 02/06/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | S0808 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.