Provider Demographics
NPI:1891181699
Name:MAO, TIFFANY F (MD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:F
Last Name:MAO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4833 INTEGRIS PKWY STE 325
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-8864
Mailing Address - Country:US
Mailing Address - Phone:405-657-3658
Mailing Address - Fax:
Practice Address - Street 1:4833 INTEGRIS PKWY STE 325
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-8864
Practice Address - Country:US
Practice Address - Phone:405-657-3658
Practice Address - Fax:405-657-3259
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10052918390200000X
OK33543207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program