Basic Information
| Provider Information | |||||||||
| NPI: | 1528292174 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DY | ||||||||
| FirstName: | TIFFANY | ||||||||
| MiddleName: | BIASON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 S EUCLID AVE | ||||||||
| Address2: | CB 8122 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101010 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149968670 | ||||||||
| FaxNumber: | 3149963195 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 BARNES WEST DR | ||||||||
| Address2: | DIV IM ALLERGY & IMMUNOLOGY, STE 200 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631416287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3149968670 | ||||||||
| FaxNumber: | 3149963195 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/12/2009 | ||||||||
| LastUpdateDate: | 11/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RA0201X | 2014003240 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 200013020 | 05 | MO | MEDICAID |