Provider Demographics
NPI:1861448987
Name:TABER, JEFFREY EVERETT (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EVERETT
Last Name:TABER
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 1:7420 REMCON CIR STE A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3537
Mailing Address - Country:US
Mailing Address - Phone:915-532-8823
Mailing Address - Fax:915-532-5909
Practice Address - Street 1:2201 N STANTON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3211
Practice Address - Country:US
Practice Address - Phone:915-533-0800
Practice Address - Fax:915-533-0885
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK4260208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103498501Medicaid
83630KMedicare ID - Type Unspecified
TX103498501Medicaid