Healthcare Provider Details

I. General information

NPI: 1104277888
Provider Name (Legal Business Name): RABIH TABET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2016
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date: 03/30/2017
Reactivation Date: 08/15/2017

III. Provider practice location address

7011 A C SKINNER PKWY STE 160
JACKSONVILLE FL
32256-6953
US

IV. Provider business mailing address

7011 A C SKINNER PKWY STE 160
JACKSONVILLE FL
32256-6953
US

V. Phone/Fax

Practice location:
  • Phone: 904-493-3333
  • Fax: 904-493-2222
Mailing address:
  • Phone: 904-493-3333
  • Fax: 904-493-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number78186
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberME174832
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: