Individual
DR. TIFFANY COURTNEY PANKOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4400 N 32ND ST, SUITE 110, PHOENIX, AZ 85018-3953
(602) 956-9595
(602) 956-3232
Mailing address
4400 N 32ND ST, SUITE 110, PHOENIX, AZ 85018-3953
(602) 956-9595
(602) 956-3232
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31622
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0409210
BCBS PROVIDER NUMBER
AZ
Enumeration date
06/21/2006
Last updated
09/30/2011
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