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Organization
PATHOLOGY ASSOCIATES OF IDAHO FALLS P A
Active
Organization
PATHOLOGY ASSOCIATES OF IDAHO FALLS P A
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT TANNENBAUM MD (PRESIDENT)
(208) 529-6050
Entity
Organization
Contact information
Practice address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-6050
Mailing address
3100 CHANNING WAY, IDAHO FALLS, ID 83404-7533
(208) 529-6111
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
NULL
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Enumeration date
03/09/2006
Last updated
03/06/2020
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