Individual
TANNER CLARKE AUSTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
650 E INDIAN SCHOOL RD, PHOENIX, AZ 85012-1839
(602) 277-5551
Mailing address
17179 W TARA LN, SURPRISE, AZ 85388-1239
(801) 874-8468
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
05/13/2025
Last updated
05/13/2025
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