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Tanner Cavanaugh
Medical Physician Assistant in Modesto, California
NPI 1811394976

Tanner Cavanaugh is a Medical Physician Assistant based in Owyhee, CA and is specialized in Medical. Tanner Cavanaugh practices in Modesto, CA. The NPI Number for Tanner Cavanaugh is 1811394976 and holds a License No. 74381 (California).

The current practice location address for Tanner Cavanaugh is 3105 Mchenry Ave Ste 101, Modesto, CA and can be reached out via phone at 209-575-2700.

Location: 3105 Mchenry Ave Ste 101, Modesto, CA, 89832
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1811394976
Provider Name
Tanner Cavanaugh
Credential
Provider Entity Type
Individual
Gender
Male
Address
3105 Mchenry Ave Ste 101, Modesto, CA, 89832
Phone Number
209-575-2700
Fax Number
Provider Enumeration Date
12/04/2014
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
74381 01 NV EMT LICENSCE
institution
Provider Business Practice Location Address Details
Address
3105 Mchenry Ave Ste 101
City
Modesto
State
California
Zip
95350-1439
Phone Number
209-575-2700
Fax Number
person
Provider Business Mailing Address Details
Address
3105 Mchenry Ave Ste 101
City
Modesto
State
California
Zip
95350-1439
Phone Number
209-575-2700
Fax Number
person
Provider's Taxonomy Details 1
Type
Emergency Medical Service Providers
Classification
Emergency Medical Technician, Basic
Speciality
-
Taxonomy
146N00000X
License No.
59206 (California)
Definition
A Basic EMT is an individual trained and certified to perform basic life support treatment in medical emergencies based on individual state boards.
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Physician Assistant
Speciality
Medical
Taxonomy
363AM0700X
License No.
74381 (Nevada)
Definition
Definition to come...
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