Provider Demographics
NPI:1801828017
Name:TABER, CYNTHIA MARIE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARIE ELIZABETH
Last Name:TABER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9406 BELLECHASE RD
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76049-4430
Mailing Address - Country:US
Mailing Address - Phone:214-244-2949
Mailing Address - Fax:
Practice Address - Street 1:9406 BELLECHASE RD
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-4430
Practice Address - Country:US
Practice Address - Phone:214-244-2949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5711207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1801828017Medicaid
MO200049234Medicaid