Healthcare Provider Details

I. General information

NPI: 1447241971
Provider Name (Legal Business Name): SHEILA MALONE TABER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 W 9TH ST
TULSA OK
74127-9020
US

IV. Provider business mailing address

4500 S GARNETT RD STE 300
TULSA OK
74146-5229
US

V. Phone/Fax

Practice location:
  • Phone: 918-728-6194
  • Fax: 918-664-2521
Mailing address:
  • Phone: 918-728-6194
  • Fax: 918-664-2521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number3792
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: