Healthcare Provider Details

I. General information

NPI: 1477870871
Provider Name (Legal Business Name): MICHAEL D'AMORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2010
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG/SGCS 101 BODIN CIRCLE
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

60 MDG/SGCS 101 BODIN CIRCLE
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3217
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101250166
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: