Provider Demographics
NPI:1972121036
Name:THORNTON, TANNER TOD (PA-C)
Entity type:Individual
Prefix:MR
First Name:TANNER
Middle Name:TOD
Last Name:THORNTON
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:20280 N 59TH AVE STE 115-617
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6850
Mailing Address - Country:US
Mailing Address - Phone:602-795-8710
Mailing Address - Fax:602-795-8701
Practice Address - Street 1:725 S DOBSON RD STE 100
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5676
Practice Address - Country:US
Practice Address - Phone:602-795-8700
Practice Address - Fax:602-795-8701
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ8056363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant