Tannenbaum, Matt

Tannenbaum, Matt is an individual health care provider with primary practice located at 3100 Channing Way , Idaho Falls ID 83404-7533. He recently has only one registered license in Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology, which is considered as his primary health care specialty. Tannenbaum, Matt can be contacted via phone (208) 529-6050.

Contact Information

Primary practice address
3100 Channing Way Idaho Falls ID 83404-7533
Phone: (208) 529-6050
Fax: (208) 529-7085
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X M7775 Idaho

Profile Details

NPI number 1093783375
LBN Legal business name Tannenbaum, Matt
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 10th, 2006
Last updated Dec 27th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1093783375 NPPES
Idaho Other 000010005388 REGENCE BLUE SHIELD ID
Idaho MEDICAID 805449000 REGENCE BLUE SHIELD ID
Idaho Other 32946 REGENCE BLUE SHIELD ID

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