Provider Demographics
NPI:1639363542
Name:GARY A TIGGES M D P A
Entity Type:Organization
Organization Name:GARY A TIGGES M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRATER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-981-8345
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:75093-8168
Mailing Address - Country:US
Mailing Address - Phone:972-981-8215
Mailing Address - Fax:972-981-8038
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:972-981-8038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4563207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00990YMedicare PIN