Individual
DR. ROCK GERARD TIFFAULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1701 S CREASY LN, LAFAYETTE, IN 47905-4972
(765) 423-6165
(765) 502-4683
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
L1219
TX
207Q00000X
Family Medicine Physician
01056196A
IN
207Q00000X
Family Medicine Physician
39496
WI
207Q00000X
Family Medicine Physician
L1219
TX
208M00000X
Hospitalist Physician
Primary
01056196A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142079626
—
TX
01
—
1578528436
SCOTT & WHITE HEALTH PLAN
TX
05
—
220226600
—
IN
01
—
8AN220
BCBS TX
TX
01
—
P00471673
RR MEDICARE
TX
Enumeration date
04/20/2006
Last updated
01/11/2024
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