Healthcare Provider Details

I. General information

NPI: 1932312675
Provider Name (Legal Business Name): GEORGE S TABOR MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3808 W RIVERSIDE DR SUITE 404
BURBANK CA
91505-4325
US

IV. Provider business mailing address

3808 W RIVERSIDE DR SUITE 404
BURBANK CA
91505-4325
US

V. Phone/Fax

Practice location:
  • Phone: 818-845-8558
  • Fax: 818-845-0339
Mailing address:
  • Phone: 818-845-8558
  • Fax: 818-845-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE S TABOR
Title or Position: PRESIDENT
Credential: MD
Phone: 818-845-8558