Healthcare Provider Details

I. General information

NPI: 1306838263
Provider Name (Legal Business Name): MAXINE C TABAS MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 08/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 LEE RD
WINTER PARK FL
32789-1834
US

IV. Provider business mailing address

1901 LEE RD
WINTER PARK FL
32789-1834
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-7300
  • Fax: 407-647-5496
Mailing address:
  • Phone: 407-647-7300
  • Fax: 407-647-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MAXINE C TABAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-647-7300