Provider Demographics
NPI:1821049826
Name:TABESH, AMANOLLAH -- (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANOLLAH
Middle Name:--
Last Name:TABESH
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 1:10131 WHITE TROUT LN
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-4309
Mailing Address - Country:US
Mailing Address - Phone:813-935-9509
Mailing Address - Fax:
Practice Address - Street 1:7001 N DALE MABRY HWY
Practice Address - Street 2:SUITE # 3
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-3910
Practice Address - Country:US
Practice Address - Phone:813-932-0804
Practice Address - Fax:813-932-8163
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41543207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30792Medicare ID - Type Unspecified
FLD85575Medicare UPIN