Provider Demographics
NPI:1346283298
Name:TANENBAUM, JEFFREY C (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:C
Last Name:TANENBAUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 GARTH RD
Mailing Address - Street 2:309
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77521-3167
Mailing Address - Country:US
Mailing Address - Phone:281-829-5932
Mailing Address - Fax:281-829-5942
Practice Address - Street 1:4201 GARTH RD
Practice Address - Street 2:309
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77521-3167
Practice Address - Country:US
Practice Address - Phone:281-829-5932
Practice Address - Fax:281-829-5942
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDP731213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT16202Medicare UPIN
TX00PK57Medicare ID - Type Unspecified