Provider Demographics
NPI:1841301256
Name:GEPHART, TAMMY KATHRYN (DPM)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:KATHRYN
Last Name:GEPHART
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:11401 SNOW LEOPARD DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-6211
Mailing Address - Country:US
Mailing Address - Phone:248-819-1770
Mailing Address - Fax:
Practice Address - Street 1:6850 N DURANGO DR STE 216
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4597
Practice Address - Country:US
Practice Address - Phone:702-851-7287
Practice Address - Fax:702-224-5653
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2062213ES0103X
GAPOD001122213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I483324OtherMEDICARE OF GA
GA273104170OtherHUMANA GROUP HEALTH PLANS
GA6489180001OtherRAILROAD MEDICARE (AUGUSTA, GA)
GA273104170OtherCOVENTRY HEALTH OF GA
GA1841301256OtherBLUE CROSS BLUE SHIELD OF GA
GA273104170OtherCIGNA
GA1811291149OtherDMERC
GA273104170OtherAETNA HEALTH PLANS
GA273104170OtherCOVENTRY HEALTH OF GA