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General NPI Number Information
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NPI Number | 1346215209
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Entity Type | Individual
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Provider Name | OWEN B. TABOR JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 04/02/2021
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Provider Practice Location Address
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Address Line | 1244 PRIMACY PKWY
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City | MEMPHIS
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State | TN
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Zip | 38119-0201
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Country | US
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Telephone | 901-767-8662
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Fax | 901-259-2785
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Provider Business Mailing Address
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Address Line | 6077 PRIMACY PKWY STE 140
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City | MEMPHIS
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State | TN
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Zip | 38119-5742
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Country | US
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Telephone | 901-725-8347
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Fax | 901-259-7637
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 31462
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 31462
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License Number State | TN
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