Provider Demographics
NPI:1659579530
Name:STARKS, TIFFANY CALLOWAY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:CALLOWAY
Last Name:STARKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11409 N CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-6121
Mailing Address - Country:US
Mailing Address - Phone:614-571-8433
Mailing Address - Fax:
Practice Address - Street 1:11409 N CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-6121
Practice Address - Country:US
Practice Address - Phone:614-571-8433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMD49624208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation