Provider Demographics
NPI:1861621609
Name:JEPSON, TIFFANI ANN (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFANI
Middle Name:ANN
Last Name:JEPSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TIFFANI
Other - Middle Name:ANN
Other - Last Name:SHIPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6770 CINCINNATI DAYTON RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-9318
Mailing Address - Country:US
Mailing Address - Phone:513-771-7213
Mailing Address - Fax:513-981-4163
Practice Address - Street 1:6770 CINCINNATI DAYTON RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TOWNSHIP
Practice Address - State:OH
Practice Address - Zip Code:45044-9318
Practice Address - Country:US
Practice Address - Phone:513-771-7213
Practice Address - Fax:513-981-4163
Is Sole Proprietor?:No
Enumeration Date:2009-07-14
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.099681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH118050Medicare PIN