Provider Demographics
NPI:1740229277
Name:ALWAY, TIFFANY (DPM)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:ALWAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3258 TIMBER FALL CT
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95503-4888
Mailing Address - Country:US
Mailing Address - Phone:707-441-1112
Mailing Address - Fax:707-441-1711
Practice Address - Street 1:3258 TIMBER FALL CT
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95503-4888
Practice Address - Country:US
Practice Address - Phone:707-441-1112
Practice Address - Fax:707-441-1711
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4464213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1639465206Medicaid
CA1639465206Medicaid
6634720001Medicare NSC