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General NPI Number Information
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NPI Number | 1306838263
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Entity Type | Organization
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Legal Business Name | MAXINE C TABAS MD PA
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Dates
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Enumeration Date | 08/17/2005
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Last Update Date | 08/17/2010
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Provider Practice Location Address
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Address Line | 1901 LEE RD
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City | WINTER PARK
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State | FL
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Zip | 32789-1834
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Country | US
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Telephone | 407-647-7300
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Fax | 407-647-5496
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Provider Business Mailing Address
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Address Line | 1901 LEE RD
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City | WINTER PARK
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State | FL
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Zip | 32789-1834
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Country | US
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Telephone | 407-647-7300
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Fax | 407-647-5496
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Authorized Official
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Title or Position | PRESIDENT
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Name | MAXINE C TABAS
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Credential | M.D.
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Telephone | 407-647-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number |
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License Number State |
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