Provider Demographics
NPI:1336439801
Name:TANNER, CLINT STEVEN (MD)
Entity type:Individual
Prefix:
First Name:CLINT
Middle Name:STEVEN
Last Name:TANNER
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 1:13780 E RICE PL STE 103
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1257
Mailing Address - Country:US
Mailing Address - Phone:720-575-5400
Mailing Address - Fax:720-709-1161
Practice Address - Street 1:13780 E RICE PL STE 103
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1257
Practice Address - Country:US
Practice Address - Phone:720-575-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-18
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD-2013-07632084P0800X, 2084P0800X
CO#DR.00547792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry