Provider Demographics
NPI:1427241199
Name:TANNER, GEORGE (CPO)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:TANNER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 STATE ROUTE 17M
Mailing Address - Street 2:SUITE 10A
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-4415
Mailing Address - Country:US
Mailing Address - Phone:845-782-9191
Mailing Address - Fax:845-782-1222
Practice Address - Street 1:400 STATE ROUTE 17M
Practice Address - Street 2:SUITE 10A
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-4415
Practice Address - Country:US
Practice Address - Phone:845-782-9191
Practice Address - Fax:845-782-1222
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist