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NPI Code Detail

MEDICARE: TIFFANY GAIL BLAND

MEDICARE: TIFFANY GAIL BLAND
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207Q00000XFamily Medicine Physician2021038378MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447755848
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY GAIL BLAND
Provider Business Mailing Address
First Line : 1000 N JEFFERSON ST
Second Line :
City : SAINT JAMES
State : MO
Zip : 65559-1078
Country : US
Telephone Number : 735-265-8840
Fax Number : 573-202-2474
Provider Business Practice Location Address
First Line : 1000 N JEFFERSON ST
Second Line :
City : SAINT JAMES
State : MO
Zip : 65559-1078
Country : US
Telephone Number : 573-265-8840
Fax Number : 573-202-2474
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2018
Last Update Date : 04/04/2025

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Directions to “ TIFFANY GAIL BLAND ” Practice Location

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