Provider Demographics
NPI:1760529986
Name:BAIRD, TIFFANY (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:
Last Name:BAIRD
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:PO BOX 6278
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-0278
Mailing Address - Country:US
Mailing Address - Phone:817-568-5467
Mailing Address - Fax:817-568-5474
Practice Address - Street 1:11803 SOUTH FWY
Practice Address - Street 2:SUITE 208
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7012
Practice Address - Country:US
Practice Address - Phone:817-568-6802
Practice Address - Fax:817-568-6805
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP6332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP6332OtherLICENSE
TX317769312Medicaid
TX349407YM36Medicare PIN