Individual ProviderTristan TannerInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address506 6th St, Brooklyn, NY 11215-3609(718) 780-3000PECOS EnrollmentBased on the most recent information from CMS, provider Tristan Tanner is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1770945461Provider TypeIndividualFull NameTanner, TristanCredentialM.D.GenderMaleSole ProprietorNoEnumeration Date3/22/2016Last Updated10/26/2021Contact InformationPractice LocationPractice Address506 6th St, Brooklyn, NY 11215-3609Phone(718) 780-3000FaxUnlisted FaxMailing LocationMailing Address506 6th St, Brooklyn, NY 11215-3609PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseME151956FloridaCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer