Provider Demographics
NPI:1528223369
Name:TABIT, JOHN MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:TABIT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 PROFESSIONAL PARK
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-3623
Mailing Address - Country:US
Mailing Address - Phone:304-410-0061
Mailing Address - Fax:304-410-0574
Practice Address - Street 1:120 PROFESSIONAL PARK
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-3623
Practice Address - Country:US
Practice Address - Phone:304-410-0061
Practice Address - Fax:304-410-0574
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2621207XX0801X
OH34.009284207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH34.009284OtherOHIO MEDICAL LICENSE
MI5101017805OtherMICHIGAN LICENSE
MI5101017805OtherMICHIGAN LICENSE
WVWV1525AMedicare PIN