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NPI Code Detail

MEDICARE: DR. DANNIE L TABOR D.O.

MEDICARE: DR. DANNIE L TABOR D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician5101006323MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1114918521
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DANNIE L TABOR D.O.
Provider Business Mailing Address
First Line : 5481 SCENIC DR
Second Line :
City : WHITEHALL
State : MI
Zip : 49461-9463
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 905 E COLBY ST
Second Line :
City : WHITEHALL
State : MI
Zip : 49461-1262
Country : US
Telephone Number : 231-728-5910
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2005
Last Update Date : 07/08/2007

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Directions to “ DR. DANNIE L TABOR D.O.” Practice Location

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