Basic Information
Provider Information | |||||||||
NPI: | 1720230782 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TIGGES | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | JO | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1356 HARBOR PARK DR | ||||||||
Address2: |   | ||||||||
City: | MEMPHIS | ||||||||
State: | TN | ||||||||
PostalCode: | 381039031 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6417991323 | ||||||||
FaxNumber: | 3305805513 | ||||||||
Practice Location | |||||||||
Address1: | 1005 PENNSYLVANIA AVE | ||||||||
Address2: | SUITE 204 | ||||||||
City: | OTTUMWA | ||||||||
State: | IA | ||||||||
PostalCode: | 525016413 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6416828761 | ||||||||
FaxNumber: | 6416822764 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/21/2008 | ||||||||
LastUpdateDate: | 10/15/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 4500 | IA | Y |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   | 207V00000X | 2382 | TN | N |   | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.