Russell J Tanner, P.A.-C
Individual provider Active NPI Medical Physician Assistant · Bridgeport, TX
NPI 1871544486 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1871544486
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA02552 (TX)
- Practice address
- 808 Woodrow Wilson Ray Cir
Bridgeport, TX 76426-2061 - Phone
- (940) 683-2297
- Fax
- (940) 683-2984
- NPI assigned
- May 16, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130703000670 | TX | Practitioner - Physician Assistant | 2365682853 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000000 | TX | MD | Emergency Medicine Physician |
| PA02552 | TX | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jon W Copeland DO PA | Current |
Accepting new patients | |
| Be Well Primary Care Medicine PLLC | Current |
Accepting new patients |
Locations
721 Southeast Pkwy
Azle, TX 76020
Phone (817) 270-3627
808 Woodrow Wilson Ray Cir
Ste 210
Bridgeport, TX 76426
808 Woodrow Wilson Ray Cir
Bridgeport, TX 76426
Phone (940) 683-2297
3800 North Tarrant Pkwy
Ste 210
Fort Worth, TX 76244
Phone (214) 919-4635
3025 N Tarrant Pkwy
Ste 320
Fort Worth, TX 76177
Phone (682) 593-6660
Interoperability endpoints
- rusty.tanner@dardp-tx.direct.office.nextgen.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA02552 | TX | Yes |
Addresses
Primary practice location
808 Woodrow Wilson Ray Cir
Bridgeport, TX 76426-2061
Mailing address
808 Woodrow Wilson Ray Cir
Bridgeport, TX 76426-2061
Phone (940) 683-2297
Other providers in Bridgeport, TX
- Southwest Healthcare Ventures
- Michaelyn Stainton
- Steve Longacre M.D. PA
- Taloni Rae Chrislynn Stone-Saturnio
- Mihir Umesh Talati
- Chandra Renee Vanvacter
- Virtue Medical Group, LLC
- Virtue Medical PA, PLLC
- Virtue Medical Physical Therapy, PLLC
- Walgreen Co
All providers in Bridgeport, TX · Medical Physician Assistant in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.