Provider Demographics
NPI:1114922119
Name:DAMORE, TIERSA HW (MD)
Entity Type:Individual
Prefix:
First Name:TIERSA
Middle Name:HW
Last Name:DAMORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2545 W FRYE RD
Mailing Address - Street 2:SUITE 9
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-6273
Mailing Address - Country:US
Mailing Address - Phone:480-505-4258
Mailing Address - Fax:480-275-8346
Practice Address - Street 1:6301 S MCCLINTOCK DR
Practice Address - Street 2:SUITE 215
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-3392
Practice Address - Country:US
Practice Address - Phone:480-820-6657
Practice Address - Fax:480-730-0803
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27567207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ472176Medicaid
AZ472176Medicaid
AZZ63957Medicare PIN