Provider Demographics
NPI:1689619017
Name:ERIC N. TABOR, M.D. A.P.M.C
Entity Type:Organization
Organization Name:ERIC N. TABOR, M.D. A.P.M.C
Other - Org Name:NORTHSHORE DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-641-5198
Mailing Address - Street 1:2780 GAUSE BLVD E
Mailing Address - Street 2:SUITE A
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4149
Mailing Address - Country:US
Mailing Address - Phone:985-641-5198
Mailing Address - Fax:985-641-5398
Practice Address - Street 1:2780 GAUSE BLVD E
Practice Address - Street 2:SUITE A
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4149
Practice Address - Country:US
Practice Address - Phone:985-641-5198
Practice Address - Fax:985-641-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1695149Medicaid
MS00119852Medicaid
LA5Y493CU52Medicare PIN
MS00119852Medicaid
MSC02746Medicare PIN