MEDICARE: DR. LOUISE A TABER M.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
1	207R00000X	Internal Medicine Physician	17349	AZ

General Provider Information

NPI Number	:	1932205127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUISE A TABER M.D.

Provider Business Mailing Address
First Line	:	2525 W GREENWAY RD
Second Line	:	SUITE 114
City	:	PHOENIX
State	:	AZ
Zip	:	85023-4226
Country	:	US
Telephone Number	:	602-863-6363
Fax Number	:	602-863-6611

Provider Business Practice Location Address
First Line	:	2525 W GREENWAY RD
Second Line	:	SUITE 114
City	:	PHOENIX
State	:	AZ
Zip	:	85023-4226
Country	:	US
Telephone Number	:	602-863-6363
Fax Number	:	602-863-6611

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	09/11/2012

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