Provider Demographics
NPI:1578776241
Name:TABEREAUX, PAUL BYRON (MD, MPH)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:BYRON
Last Name:TABEREAUX
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 FRANKLIN ST SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4312
Mailing Address - Country:US
Mailing Address - Phone:256-539-4080
Mailing Address - Fax:256-539-4099
Practice Address - Street 1:930 FRANKLIN ST SE
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4312
Practice Address - Country:US
Practice Address - Phone:256-539-4080
Practice Address - Fax:256-539-4099
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26602207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP00746293OtherRAILROAD MEDICARE
AL510-48687OtherBCBS
AL112153Medicaid
AL510-49313OtherBCBS
AL510-49314OtherBCBS
AL110103Medicaid
AL112142Medicaid
AL515-99689OtherBCBS
AL112152Medicaid
AL515-99692OtherBCBS
AL112150Medicaid
AL510-48688OtherBCBS
AL515-99691OtherBCBS
AL112146Medicaid
AL112154Medicaid
AL510-49312OtherBCBS
AL515-99691OtherBCBS
AL510-49312OtherBCBS