Provider Demographics
NPI:1609069103
Name:NAJBERG, TIFFANY ALEXIS (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ALEXIS
Last Name:NAJBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-2830
Mailing Address - Country:US
Mailing Address - Phone:318-299-6512
Mailing Address - Fax:318-299-6512
Practice Address - Street 1:201 MARKET ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-2830
Practice Address - Country:US
Practice Address - Phone:318-801-4120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2023-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LADO.000009261QP2300X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02408202Medicaid
LA1064203Medicaid
LA1064203Medicaid
LA4K708Medicare PIN