Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | A134817 | CA |
N | 207XX0801X | Orthopaedic Trauma Surgeon | A134817 | CA |
NPI | 1285952655 |
---|---|
Provider Name | Oliver O Tannous |
First Address | San Diego, CA 92103 |
Second Address | San Diego, CA 92103-1913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2010 |
Last Update Date | 11/12/2015 |