Healthcare Provider Details

I. General information

NPI: 1316925456
Provider Name (Legal Business Name): AUBREY DOZIER TABB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

497 W LOTT ST
BUFFALO WY
82834-1609
US

IV. Provider business mailing address

1 HILLSIDE DRIVE
BUFFALO WY
82834-1609
US

V. Phone/Fax

Practice location:
  • Phone: 307-684-2228
  • Fax: 307-684-2177
Mailing address:
  • Phone: 307-684-1390
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5076A
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: