Healthcare Provider Details

I. General information

NPI: 1528223369
Provider Name (Legal Business Name): JOHN MICHAEL TABIT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 03/07/2023
Certification Date: 01/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PROFESSIONAL PARK
BECKLEY WV
25801-3623
US

IV. Provider business mailing address

120 PROFESSIONAL PARK
BECKLEY WV
25801-3623
US

V. Phone/Fax

Practice location:
  • Phone: 304-410-0061
  • Fax: 304-410-0574
Mailing address:
  • Phone: 304-410-0061
  • Fax: 304-410-0574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34.009284
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number2621
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: