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General NPI Number Information
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NPI Number | 1013012756
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL TABOR PA-C
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Gender | Male
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 12/18/2024
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Provider Practice Location Address
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Address Line | 1001 RIO VISTA DR
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City | FALLON
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State | NV
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Zip | 89406-5463
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Country | US
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Telephone | 775-423-3634
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 RIO VISTA DR
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City | FALLON
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State | NV
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Zip | 89406-5463
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Country | US
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Telephone | 775-423-3634
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Fax | 775-423-4319
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA3080
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License Number State | NV
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