Basic Information
| Provider Information | |||||||||
| NPI: | 1023084308 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIFFIN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2401 W MAIN ST | ||||||||
| Address2: | VETERANS ADMIN HOSP | ||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629591194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189985617 | ||||||||
| FaxNumber: | 6189985697 | ||||||||
| Practice Location | |||||||||
| Address1: | 2401 W MAIN ST | ||||||||
| Address2: | VETERANS ADMIN HOSP | ||||||||
| City: | MARION | ||||||||
| State: | IL | ||||||||
| PostalCode: | 629591194 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6189985617 | ||||||||
| FaxNumber: | 6189985697 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.