Healthcare Provider Details

I. General information

NPI: 1306343322
Provider Name (Legal Business Name): TIFFANY PAULINE WHIPPLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAULI WHIPPLE DO

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 08/21/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2448 E 81ST ST STE 1100
TULSA OK
74137-4205
US

IV. Provider business mailing address

1215 HADLEY RD STE 201
MOORESVILLE IN
46158-2907
US

V. Phone/Fax

Practice location:
  • Phone: 918-505-3400
  • Fax: 918-508-7070
Mailing address:
  • Phone: 317-834-9618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number6797
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number02007024A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: