Provider Demographics
NPI:1659840387
Name:TIFFER, THOMAS N
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:N
Last Name:TIFFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 841
Mailing Address - Street 2:
Mailing Address - City:MONTE RIO
Mailing Address - State:CA
Mailing Address - Zip Code:95462-0841
Mailing Address - Country:US
Mailing Address - Phone:707-849-6802
Mailing Address - Fax:
Practice Address - Street 1:14701 CANYON 7 RD
Practice Address - Street 2:
Practice Address - City:GUERNEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95446
Practice Address - Country:US
Practice Address - Phone:707-849-6802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-26
Last Update Date:2018-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes344600000XTransportation ServicesTaxi
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA$$$$$$$$$OtherNATIONAL MEDICAL TRANSPORTATION