Basic Information
| Provider Information | |||||||||
| NPI: | 1326199134 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAER | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 626 D ST | ||||||||
| Address2: | |||||||||
| City: | DAVIS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956163714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163876929 | ||||||||
| FaxNumber: | 9163876977 | ||||||||
| Practice Location | |||||||||
| Address1: | 902 SANTA FE AVE | ||||||||
| Address2: | |||||||||
| City: | ALBANY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947062120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105265256 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 02/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A67112 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.