Healthcare Provider Details

I. General information

NPI: 1679732036
Provider Name (Legal Business Name): TAMARA ZORIANNA VERN-GROSS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA ZORIANNA VERN DO

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 5TH ST
MONROE WI
53566-1546
US

IV. Provider business mailing address

13400 E SHEA BLVD MAYO CLINIC ARIZONA
SCOTTSDALE AZ
85259-5452
US

V. Phone/Fax

Practice location:
  • Phone: 608-324-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2009-00655
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2703
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number006864
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberDO-06803
License Number StateIA
# 5
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number2703
License Number StateTN
# 6
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number006864
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2703
License Number StateTN
# 8
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number2009-00655
License Number StateNC
# 9
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number006864
License Number StateAZ
# 10
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2009-00655
License Number StateNC
# 11
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number81684
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: