Provider Demographics
NPI:1093825408
Name:VON WALD, TIFFANY A (MD)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:VON WALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10290 RIDGEGATE CIR
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5331
Mailing Address - Country:US
Mailing Address - Phone:303-788-8300
Mailing Address - Fax:303-788-8310
Practice Address - Street 1:10290 RIDGEGATE CIR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5331
Practice Address - Country:US
Practice Address - Phone:303-788-8300
Practice Address - Fax:303-788-8310
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD8677207VE0102X
CO49434207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology