Provider Demographics
NPI:1275755084
Name:HARRIS, TIFFANY FONTAINE (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:FONTAINE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TIFFANY
Other - Middle Name:LAMAR
Other - Last Name:FONTAINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:801 E 6TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-3661
Mailing Address - Country:US
Mailing Address - Phone:850-785-3185
Mailing Address - Fax:850-785-6233
Practice Address - Street 1:801 E 6TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-3661
Practice Address - Country:US
Practice Address - Phone:850-785-3185
Practice Address - Fax:850-785-6233
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME104331207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology