Provider Demographics
NPI:1255484820
Name:TAUBER, JACOB E (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:E
Last Name:TAUBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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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:90211-1837
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:90211-1837
Practice Address - Country:US
Practice Address - Phone:310-273-1003
Practice Address - Fax:310-273-2551
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2014-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG41526207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16723Medicare UPIN
A48598Medicare UPIN