Provider Demographics
NPI:1902883259
Name:TIFFANY, CAROLYN ARLENE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ARLENE
Last Name:TIFFANY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 WORTH RD
Mailing Address - Street 2:MEDCOM QM
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-7533
Mailing Address - Country:US
Mailing Address - Phone:210-221-6195
Mailing Address - Fax:
Practice Address - Street 1:2050 WORTH RD
Practice Address - Street 2:MEDCOM QM
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-7533
Practice Address - Country:US
Practice Address - Phone:210-221-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD050719L207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine