Provider Demographics
NPI:1235393208
Name:ANTHONY, TIFFANY L (MD)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 FOREST LN STE B446
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2571
Mailing Address - Country:US
Mailing Address - Phone:972-566-8822
Mailing Address - Fax:972-566-8861
Practice Address - Street 1:7777 FOREST LN STE B446
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-566-8822
Practice Address - Fax:972-566-8861
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9808204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198139101Medicaid
TX8H8678OtherBC/BS
TX198139103Medicaid
TX198139104Medicaid
TX8L0705Medicare PIN
TX198139103Medicaid
TX198139104Medicaid