Basic Information
| Provider Information | |||||||||
| NPI: | 1508183476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | CAROLYN | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WILLIAMS | ||||||||
| OtherFirstName: | TIFFANY | ||||||||
| OtherMiddleName: | CAROLYN | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 606 S LAKE ST | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467429678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7655467208 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1316 E 7TH ST | ||||||||
| Address2: | |||||||||
| City: | AUBURN | ||||||||
| State: | IN | ||||||||
| PostalCode: | 467062538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2609254600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2010 | ||||||||
| LastUpdateDate: | 07/24/2020 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 07/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD0000049505 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 01084184A | IN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.