Provider Demographics
NPI:1124472964
Name:FERDERER, TANNER
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:
Last Name:FERDERER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 COMMONS WAY STE C
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1915
Mailing Address - Country:US
Mailing Address - Phone:406-752-5095
Mailing Address - Fax:406-751-3079
Practice Address - Street 1:200 COMMONS WAY STE C
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1915
Practice Address - Country:US
Practice Address - Phone:406-752-5095
Practice Address - Fax:406-751-3079
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-18
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-998822084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology