Provider Demographics
NPI:1851827695
Name:MCGUIRE, TIFFANIE MANN (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:MANN
Last Name:MCGUIRE
Suffix:
Gender:F
Credentials:DO
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 2705
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-2705
Mailing Address - Country:US
Mailing Address - Phone:256-265-5970
Mailing Address - Fax:256-265-5971
Practice Address - Street 1:450 LANIER RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-1866
Practice Address - Country:US
Practice Address - Phone:256-265-5970
Practice Address - Fax:256-265-5971
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO1928207Q00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL512-47782OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL512-59453OtherBCBS OF ALABAMA