=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528280310
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TIFFANY LARAE BEGGS D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/03/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 260 S ARCHIE ST
-----------------------------------------------------
City | VIDOR
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77662-4839
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-769-5800
-----------------------------------------------------
Fax | 409-769-5804
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2260 ASHLEY ST
-----------------------------------------------------
City | BEAUMONT
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77701-1022
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 409-212-8887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | K8875
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------