{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "GARETH A. TABOR M.D., P.C",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
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"Credential": null,
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"FirstLineMailingAddress": "27 S STATE ST",
"SecondLineMailingAddress": "#240",
"MailingAddressCityName": "LAKE OSWEGO",
"MailingAddressStateName": "OR",
"MailingAddressPostalCode": "97034-3935",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "503-636-9608",
"MailingAddressFaxNumber": "503-636-9600",
"FirstLinePracticeLocationAddress": "27 S STATE ST",
"SecondLinePracticeLocationAddress": "#240",
"PracticeLocationAddressCityName": "LAKE OSWEGO",
"PracticeLocationAddressStateName": "OR",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "503-636-9608",
"PracticeLocationAddressFaxNumber": "503-636-9600",
"EnumerationDate": "11/08/2007",
"LastUpdateDate": "10/09/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TABOR",
"AuthorizedOfficialFirstName": "JANET",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "OFFICE MANAGER",
"AuthorizedOfficialNamePrefix": "MS.",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "503-636-9608",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "15143",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}