Individual
TANNER D MITTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1355 PARKWAY DR STE A, BLACKFOOT, ID 83221-1656
(986) 275-0003
(986) 275-0005
Mailing address
1355 PARKWAY DR STE A, BLACKFOOT, ID 83221-1656
(986) 275-0003
(986) 275-0005
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1262
ID
363A00000X
Physician Assistant
—
—
Other
Enumeration date
06/18/2015
Last updated
06/30/2026
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