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NPI Code Detail

MEDICARE: DR. IRIS TABER PH.D.

MEDICARE: DR. IRIS TABER PH.D.
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
1103TC0700XClinical Psychologist32785TX

General Provider Information

NPI Number : 1710924287
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IRIS TABER PH.D.
Provider Business Mailing Address
First Line : 4240 SOUTHWEST BLVD
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-5634
Country : US
Telephone Number : 325-658-6138
Fax Number :
Provider Business Practice Location Address
First Line : 4240 SOUTHWEST BLVD
Second Line :
City : SAN ANGELO
State : TX
Zip : 76904-5634
Country : US
Telephone Number : 325-658-6138
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 07/28/2023

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