Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | OP 60329393 | WA |
N | 208600000X | Surgeon | OP 60329393 | WA |
N | 208200000X | Surgeon | OS 12793 | FL |
N | 208600000X | Surgeon | OS 12793 | FL |
N | 2082S0105X | Plastic Hand Surgeon | 259626 | NY |
N | 208200000X | Surgeon | 005932 | AZ |
N | 208600000X | Surgeon | 005932 | AZ |
N | 208200000X | Surgeon | 259626 | NY |
N | 208600000X | Surgeon | 259626 | NY |
N | 208200000X | Surgeon | OP 60329393 | WA |
N | 208600000X | Surgeon | OP 60329393 | WA |
N | 208200000X | Surgeon | OS 12793 | FL |
N | 208600000X | Surgeon | OS 12793 | FL |
N | 2086S0127X | Trauma Surgeon | 005932 | AZ |
Y | 2086S0127X | Trauma Surgeon | 259626 | NY |
N | 2086S0127X | Trauma Surgeon | OS 12793 | FL |
NPI | 1952607251 |
---|---|
Provider Name | Dr. Tiffany Brook Reavis |
First Address | Brooklyn, NY 11220-2508 |
Second Address | Brooklyn, NY 11220-2508 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2011 |
Last Update Date | 02/09/2016 |