Provider Demographics
NPI:1285952655
Name:TANNOUS, OLIVER O (MD)
Entity type:Individual
Prefix:
First Name:OLIVER
Middle Name:O
Last Name:TANNOUS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:350 DICKINSON STREET
Mailing Address - Street 2:SUITE 121
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103
Mailing Address - Country:US
Mailing Address - Phone:858-248-6456
Mailing Address - Fax:
Practice Address - Street 1:350 DICKINSON ST
Practice Address - Street 2:SUITE 121, MC 8894
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-1913
Practice Address - Country:US
Practice Address - Phone:858-248-6456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA134817207XS0117X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma