MEDICARE: DR. MICHAEL JOSEPH TARBOX D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	SC005851	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	122869JT3	OTHER	PA	MEDICARE ID

General Provider Information

NPI Number	:	1457363590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL JOSEPH TARBOX D.P.M.

Provider Business Mailing Address
First Line	:	1755 US ROUTE 6 W
Second Line	:
City	:	ROULETTE
State	:	PA
Zip	:	16746-1025
Country	:	US
Telephone Number	:	814-544-3182
Fax Number	:	814-544-3184

Provider Business Practice Location Address
First Line	:	1755 US ROUTE 6 W
Second Line	:
City	:	ROULETTE
State	:	PA
Zip	:	16746-1025
Country	:	US
Telephone Number	:	814-544-3182
Fax Number	:	814-544-3184

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	10/19/2020

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