Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | M7041 | TX |
NPI | 1003013343 |
---|---|
Provider Name | Dr. Tiffany Jones Berry |
First Address | Rogers, TX 76569-3790 |
Second Address | Temple, TX 76508-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2007 |
Last Update Date | 20/08/2013 |