Provider Demographics
NPI:1528292174
Name:DY, TIFFANY BIASON (MD)
Entity type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:BIASON
Last Name:DY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412011
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2011
Mailing Address - Country:US
Mailing Address - Phone:314-996-8670
Mailing Address - Fax:866-362-4984
Practice Address - Street 1:5201 MID AMERICA PLZ
Practice Address - Street 2:DIV IM ALLERGY AND IMMUNOLOGY, STE 2300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-0002
Practice Address - Country:US
Practice Address - Phone:314-996-8670
Practice Address - Fax:866-362-4984
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014003240207RA0201X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200013020Medicaid
ILENROLLEDMedicaid