Individual
TANNER SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1130 W PRAIRIE AVE, COEUR D ALENE, ID 83815-8780
(208) 209-0288
(208) 209-0289
Mailing address
PO BOX 1517, PENDLETON, OR 97801-0410
(541) 278-4332
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0-1993
ID
208D00000X
General Practice Physician
DO3477
NV
Other
Enumeration date
03/27/2021
Last updated
08/23/2024
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