RUSSELL J TANNER

BRIDGEPORT, TX
NPI1871544486
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: TX  PA02552)
Enumeration Date2006-05-16
Last Update Date2007-07-08
Business Address
-- RUSSELL J TANNER P.A.-C
808 WOODROW WILSON RAY CIR
BRIDGEPORT, TX 76426-2061
Phone number: 940-683-2297
Mailing Address
-- RUSSELL J TANNER P.A.-C
808 WOODROW WILSON RAY CIR
BRIDGEPORT, TX 76426-2061
Phone number: 940-683-2297
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