Provider Demographics
NPI:1346405636
Name:HARVEY, TIFFANY GILLAM (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:GILLAM
Last Name:HARVEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:400 W IH 635 FWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3718
Mailing Address - Country:US
Mailing Address - Phone:972-406-1199
Mailing Address - Fax:972-556-2593
Practice Address - Street 1:400 W IH 635 FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3718
Practice Address - Country:US
Practice Address - Phone:972-406-1199
Practice Address - Fax:972-556-2593
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2015-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXN9704208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2851107-01Medicaid
TXTXB137612Medicare PIN