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General NPI Number Information
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NPI Number | 1396734869
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Entity Type | Individual
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Provider Name | MARWAN RIAD TABBARA M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/18/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2951 NW 49TH AVE SUITE 204, CENTRAL BLDG
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-1600
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Country | US
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Telephone | 954-486-5311
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Fax |
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Provider Business Mailing Address
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Address Line | 20101 NE 25TH AVE
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City | MIAMI
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State | FL
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Zip | 33180-1822
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Country | US
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Telephone | 305-931-6052
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Fax |
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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 | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME-0045701
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License Number State | FL
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