Healthcare Provider Details

I. General information

NPI: 1134286115
Provider Name (Legal Business Name): JEFFREY TABER MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 HOSPITAL DR STE A
WINDOM MN
56101-1287
US

IV. Provider business mailing address

PO BOX 187
WINDOM MN
56101-0187
US

V. Phone/Fax

Practice location:
  • Phone: 507-831-2550
  • Fax: 507-831-5528
Mailing address:
  • Phone: 507-831-2550
  • Fax: 507-831-5528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY D TABER
Title or Position: PROVIDER
Credential: MD
Phone: 507-831-2550