Individual
TANNER S. ELLSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
81 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1125
(801) 662-5700
Mailing address
81 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1125
(801) 662-5700
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12974676-1205
UT
Other
Enumeration date
03/30/2021
Last updated
08/10/2022
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