Healthcare Provider Details

I. General information

NPI: 1124160148
Provider Name (Legal Business Name): ADAM JOHN TABET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 RYAN RD
BUCKLEY WA
98321-9115
US

IV. Provider business mailing address

421 8TH AVE NW
PUYALLUP WA
98371-4175
US

V. Phone/Fax

Practice location:
  • Phone: 360-829-3069
  • Fax:
Mailing address:
  • Phone: 253-446-0743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD00035550
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: