Healthcare Provider Details

I. General information

NPI: 1962480491
Provider Name (Legal Business Name): SAMUEL K TABET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 CEDAR ST SE SUITE 6600
ALBUQUERQUE NM
87106-4917
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-724-4300
  • Fax: 505-724-4384
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-724-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number81-325
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number81-325
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: