Healthcare Provider Details

I. General information

NPI: 1013414218
Provider Name (Legal Business Name): STANIS LOUIS TABLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 NEW THOMAS DR
CHARLES TOWN WV
25414-4822
US

IV. Provider business mailing address

41 NEW THOMAS DR
CHARLES TOWN WV
25414-4822
US

V. Phone/Fax

Practice location:
  • Phone: 304-283-7215
  • Fax:
Mailing address:
  • Phone: 42-837-2153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: