Provider Demographics
NPI:1275576779
Name:TIGGES, GARY A (MD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:A
Last Name:TIGGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6300 W PARKER RD
Mailing Address - Street 2:#220
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8100
Mailing Address - Country:US
Mailing Address - Phone:972-981-8215
Mailing Address - Fax:
Practice Address - Street 1:6300 W PARKER RD
Practice Address - Street 2:#220
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8168
Practice Address - Country:US
Practice Address - Phone:972-981-8215
Practice Address - Fax:972-981-3099
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R36YOtherBCBS
TXP00050670OtherRAILROAD MEDICARE
TX5384035OtherAETNA
TXP00050670OtherRAILROAD MEDICARE
TX8F0369Medicare PIN