Individual
MATTHEW TANNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
530 S WAKARA WAY, SALT LAKE CITY, UT 84108-1213
(801) 587-2162
Mailing address
1657 24TH PL NE, ISSAQUAH, WA 98029-2638
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/27/2017
Last updated
04/27/2017
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