Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | M9808 | TX |
NPI | 1235393208 |
---|---|
Provider Name | Tiffany L Anthony |
First Address | Dallas, TX 75230-2571 |
Second Address | Dallas, TX 75230 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 01/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
198139101 | (05) | TX |
198139103 | (05) | TX |
198139104 | (05) | TX |
8H8678 | BC/BS (01) | TX |