Provider Demographics
NPI:1457732224
Name:SVOBODA, TIFFANY L (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:L
Last Name:SVOBODA
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 100
Mailing Address - Street 2:
Mailing Address - City:CALLAWAY
Mailing Address - State:NE
Mailing Address - Zip Code:68825-0100
Mailing Address - Country:US
Mailing Address - Phone:308-836-2294
Mailing Address - Fax:308-836-2733
Practice Address - Street 1:213 E KIMBALL ST
Practice Address - Street 2:
Practice Address - City:CALLAWAY
Practice Address - State:NE
Practice Address - Zip Code:68825-2596
Practice Address - Country:US
Practice Address - Phone:308-836-2294
Practice Address - Fax:402-836-2733
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine