MEDICARE: TOM TABOR P.A

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
1	363A00000X	Physician Assistant	100237	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100237	OTHER	NC	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1457439523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOM TABOR P.A

Provider Business Mailing Address
First Line	:	345 HOLLY HILLS RD
Second Line	:
City	:	SYLVA
State	:	NC
Zip	:	28779-6962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 BIRD LANE
Second Line	:	UNIVERSITY HEALTH CENTER
City	:	CULLOWHEE
State	:	NC
Zip	:	28723
Country	:	US
Telephone Number	:	828-227-7640
Fax Number	:	828-227-7400

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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Directions to “ TOM TABOR P.A” Practice Location

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