Provider Demographics
NPI:1346233921
Name:ADAMS, TAMERUT ANNA (DO)
Entity Type:Individual
Prefix:DR
First Name:TAMERUT
Middle Name:ANNA
Last Name:ADAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:117 E MAIN ST STE A100
Mailing Address - Street 2:
Mailing Address - City:PAYSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85541-4606
Mailing Address - Country:US
Mailing Address - Phone:928-596-4500
Mailing Address - Fax:928-596-4545
Practice Address - Street 1:117 E MAIN ST STE A100
Practice Address - Street 2:
Practice Address - City:PAYSON
Practice Address - State:AZ
Practice Address - Zip Code:85541-4606
Practice Address - Country:US
Practice Address - Phone:928-596-4500
Practice Address - Fax:928-596-4545
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ006740207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209174705Medicaid
MO209174705Medicaid
MOI11403Medicare UPIN