Individual
TANNER ROSS MORTENSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
5505 S 900 E STE 240, MURRAY, UT 84117-7210
(801) 783-5011
Mailing address
5505 S 900 E STE 240, MURRAY, UT 84117-7210
(801) 783-5011
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
12322379-1204
UT
207R00000X
Internal Medicine Physician
20A17016
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/17/2017
Last updated
07/14/2021
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