Provider Demographics
NPI:1396066049
Name:TANTCHOU DSAMOU, PIERRETTE MARIE ANGE (MD)
Entity type:Individual
Prefix:DR
First Name:PIERRETTE
Middle Name:MARIE ANGE
Last Name:TANTCHOU DSAMOU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PIERRETTE
Other - Middle Name:MARIE-ANGE
Other - Last Name:TANTCHOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:14200 W CELEBRATE LIFE WAY
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-3007
Mailing Address - Country:US
Mailing Address - Phone:856-283-5454
Mailing Address - Fax:
Practice Address - Street 1:14200 W CELEBRATE LIFE WAY
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-3007
Practice Address - Country:US
Practice Address - Phone:856-283-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ47837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine