Russell J Tanner, P.A.-C
NPI #1871544486 in Bridgeport, Texas
Provider Information
- NPI Number
- 1871544486
- Entity Type
- Individual
- Name
- Russell J Tanner, P.A.-C
- Gender
- Not Specified
- Sole Proprietor
- Not Answered
- Primary Specialty
- Physician Assistant - Medical
- Credential
- P.A.-C
- Enumeration Date
- May 16, 2006
- Last Updated
- Jul 8, 2007
Practice Location
- Address
- 808 WOODROW WILSON RAY CIR
- City
- Bridgeport
- State
- Texas
- ZIP Code
- 76426-2061
- Phone
- (940) 683-2297
Specialties & Taxonomy Codes
| Specialty |
|---|
| Physician Assistant - Medical — Medical |
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