Provider Demographics
NPI:1386407427
Name:SMITH, TANNER MORGAN (DO)
Entity type:Individual
Prefix:
First Name:TANNER
Middle Name:MORGAN
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4648 DELWOOD PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32408-7128
Mailing Address - Country:US
Mailing Address - Phone:850-276-9258
Mailing Address - Fax:
Practice Address - Street 1:590 MEDICAL CENTER RD
Practice Address - Street 2:ATTN: RESIDENCY CENTER
Practice Address - City:APO
Practice Address - State:AA
Practice Address - Zip Code:76544
Practice Address - Country:US
Practice Address - Phone:850-276-9258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program