Provider Demographics
NPI:1942275367
Name:TABB, YACARA (DPM)
Entity Type:Individual
Prefix:DR
First Name:YACARA
Middle Name:
Last Name:TABB
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:843 MILLING AVE
Mailing Address - Street 2:
Mailing Address - City:LULING
Mailing Address - State:LA
Mailing Address - Zip Code:70070-4442
Mailing Address - Country:US
Mailing Address - Phone:985-785-5800
Mailing Address - Fax:985-785-5811
Practice Address - Street 1:843 MILLING AVE
Practice Address - Street 2:PODIATRY DEPT
Practice Address - City:LULING
Practice Address - State:LA
Practice Address - Zip Code:70070-4442
Practice Address - Country:US
Practice Address - Phone:985-785-5800
Practice Address - Fax:985-785-5811
Is Sole Proprietor?:No
Enumeration Date:2006-02-20
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPD177R213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1685585Medicaid
LA4E162CD42Medicare PIN
LA4E162Medicare PIN
LA1685585Medicaid
LA6485840001Medicare NSC