1457396087 NPI number — TIFFANY DAWN RIORDAN M.D.

Table of content: TIFFANY DAWN RIORDAN M.D. (NPI 1457396087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457396087 NPI number — TIFFANY DAWN RIORDAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RIORDAN
Provider First Name:
TIFFANY
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457396087
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
RCO PROVIDER ENROLLMENT
Provider Second Line Business Mailing Address:
2401 S 31ST ST MS-AR-M200
Provider Business Mailing Address City Name:
TEMPLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76508-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-724-2111
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRENHAM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77833-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-994-0371
Provider Business Practice Location Address Fax Number:
254-215-9722
Provider Enumeration Date:
06/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  M8955 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20055495 . This is a "AMERIHEALTH MERCY-YH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: P00341561 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2592 . This is a "GEISINGER-YH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1865780 . This is a "HIGHMARK BLUE SHIELD-YH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50067239 . This is a "CAPITAL BLUE CROSS-YH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 203883 . This is a "JOHNS HOPKINS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 101648686 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548643 . This is a "GATEWAY-YH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 200941 . This is a "UNISON YH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2724605000 . This is a "AMERIHEALTH 65 PA-YH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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