Provider Demographics
NPI:1679732036
Name:VERN-GROSS, TAMARA ZORIANNA (DO)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ZORIANNA
Last Name:VERN-GROSS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:ZORIANNA
Other - Last Name:VERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:13400 E SHEA BLVD
Mailing Address - Street 2:MAYO CLINIC ARIZONA
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-5452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13400 E SHEA BLVD
Practice Address - Street 2:MAYO CLINIC ARIZONA
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-5452
Practice Address - Country:US
Practice Address - Phone:480-301-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00655208000000X, 2080H0002X, 2085R0001X
TN2703208000000X, 2080H0002X, 2085R0001X
AZ006864208000000X, 2080H0002X, 2085R0001X
IADO-068032085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080H0002XAllopathic & Osteopathic PhysiciansPediatricsHospice and Palliative Medicine