Individual
BRANDON DEE TANNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
388 MARTIN ST, TWIN FALLS, ID 83301-4544
(208) 734-0451
(208) 734-0452
Mailing address
794 EASTLAND DR, TWIN FALLS, ID 83301-6856
(208) 737-6718
(208) 734-5036
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA-1058
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
289207701
—
TX
01
—
865N24
BCBS TEXAS
TX
Enumeration date
10/24/2011
Last updated
03/17/2021
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