Provider Demographics
NPI:1225226616
Name:JACOB E TAUBER MD A PROFESSIONAL
Entity Type:Organization
Organization Name:JACOB E TAUBER MD A PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-273-1003
Mailing Address - Street 1:9033 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1847
Mailing Address - Country:US
Mailing Address - Phone:310-273-1003
Mailing Address - Fax:310-273-2551
Practice Address - Street 1:9033 WILSHIRE BLVD
Practice Address - Street 2:SUITE 401
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1847
Practice Address - Country:US
Practice Address - Phone:310-273-1003
Practice Address - Fax:310-273-2551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41526207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16723Medicare PIN
CAA48598Medicare UPIN