IndividualActive
Matt Tannenbaum, MD
NPI 1093783375 · Anatomic Pathology & Clinical Pathology Physician · Idaho Falls, ID
Provider details
- NPI number
- 1093783375
- Entity type
- Individual
- Primary specialty
- Anatomic Pathology & Clinical Pathology PhysicianAllopathic & Osteopathic Physicians
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- License
- M7775 (ID)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
3100 Channing Way
Idaho Falls, ID 83404-7533
Phone: (208) 529-6050
Fax: (208) 529-7085
Approximate (ZIP-level) locationGet directions
Mailing address
1820 E 17th St
Idaho Falls, ID 83404-6521
Registry dates
- Enumerated
- 2006-03-10
- Last updated
- 2012-12-27
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.