Provider Demographics
NPI:1689673972
Name:FRATIANNI, TAMARAH (DO)
Entity Type:Individual
Prefix:
First Name:TAMARAH
Middle Name:
Last Name:FRATIANNI
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 1:1340 N RIM DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3111
Mailing Address - Country:US
Mailing Address - Phone:928-774-1873
Mailing Address - Fax:928-774-5525
Practice Address - Street 1:1340 N RIM DR
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3111
Practice Address - Country:US
Practice Address - Phone:928-774-1873
Practice Address - Fax:928-774-5525
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3000207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG07076Medicare UPIN