MEDICARE: DR. TIFFANI ANN JEPSON M.D.

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
1	207Q00000X	Family Medicine Physician	35.099681	OH

General Provider Information

NPI Number	:	1861621609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIFFANI ANN JEPSON M.D.

Provider Business Mailing Address
First Line	:	6770 CINCINNATI DAYTON RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9318
Country	:	US
Telephone Number	:	513-771-7213
Fax Number	:	513-981-4163

Provider Business Practice Location Address
First Line	:	6770 CINCINNATI DAYTON RD
Second Line	:
City	:	LIBERTY TOWNSHIP
State	:	OH
Zip	:	45044-9318
Country	:	US
Telephone Number	:	513-771-7213
Fax Number	:	513-981-4163

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	09/06/2012

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