Provider Demographics
NPI:1083903249
Name:TANNER, MICHAEL STERLING (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:STERLING
Last Name:TANNER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10655 PARK RUN DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-4590
Mailing Address - Country:US
Mailing Address - Phone:702-686-3762
Mailing Address - Fax:913-871-9266
Practice Address - Street 1:10655 PARK RUN DR STE 210
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-4590
Practice Address - Country:US
Practice Address - Phone:702-686-3762
Practice Address - Fax:913-871-9266
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV155342084P0804X, 2084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry