Individual
TANNER D MITTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
950 HOSPITAL WAY, STE A, POCATELLO, ID 83201-2762
(208) 478-4522
(208) 712-6868
Mailing address
950 HOSPITAL WAY, STE A, POCATELLO, ID 83201-2762
(208) 478-4522
(208) 712-6868
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
04/26/2017
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