Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 31822 | TX |
N | 1223G0001X | General Practice | 58986 | CA |
N | 213EG0000X | General Practice | 58986 | CA |
NPI | 1104155647 |
---|---|
Provider Name | Dr. Tiffany Rose Gorr |
First Address | Austin, TX 78758-4013 |
Second Address | Austin, TX 78758-3801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2009 |
Last Update Date | 02/02/2017 |