Provider Demographics
NPI:1679551949
Name:TABE, WILSON EGBE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILSON
Middle Name:EGBE
Last Name:TABE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 WAYNE MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-2235
Mailing Address - Country:US
Mailing Address - Phone:919-735-3311
Mailing Address - Fax:
Practice Address - Street 1:1402 WAYNE MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-2252
Practice Address - Country:US
Practice Address - Phone:919-735-3311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-05
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200101288207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912923Medicaid
NCH50457Medicare UPIN
NC2289146Medicare ID - Type Unspecified