Provider Demographics
NPI:1053627216
Name:FOUSE, TAMMY SUE (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:SUE
Last Name:FOUSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 KAUFFMANS CRK
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:44216-8657
Mailing Address - Country:US
Mailing Address - Phone:330-529-4015
Mailing Address - Fax:
Practice Address - Street 1:2486 CIMMARON CIR
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-7346
Practice Address - Country:US
Practice Address - Phone:440-258-0073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58003533208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery