Healthcare Provider Details

I. General information

NPI: 1770587404
Provider Name (Legal Business Name): WILLIAM G TABBERT D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date: 03/16/2006
Reactivation Date: 03/21/2006

III. Provider practice location address

1125 ELLEN KAY DR STE E
MARION OH
43302-6358
US

IV. Provider business mailing address

1125 ELLEN KAY DR STE E
MARION OH
43302-6358
US

V. Phone/Fax

Practice location:
  • Phone: 740-387-2274
  • Fax: 740-382-0600
Mailing address:
  • Phone: 740-387-2274
  • Fax: 740-382-0600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2025
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: