Provider Demographics
NPI:1942275896
Name:TABOR, OWEN B SR (MD)
Entity Type:Individual
Prefix:
First Name:OWEN
Middle Name:B
Last Name:TABOR
Suffix:SR
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:PO BOX 8888
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8888
Mailing Address - Country:US
Mailing Address - Phone:901-259-4260
Mailing Address - Fax:901-259-2785
Practice Address - Street 1:1244 PRIMACY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0201
Practice Address - Country:US
Practice Address - Phone:901-767-8662
Practice Address - Fax:901-259-2785
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6996207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07187860Medicaid
TN3179854Medicaid
TN3371161Medicaid
TN4179726OtherBCBS
TN4442032OtherCIGNA
MS120469Medicaid
TN620819926OtherCIGNA
TNP00624370OtherRAILROAD MEDICARE
TN00000207490 08OtherUNITED HEALTHCARE
TN4039349OtherAETNA
TN620819926OtherAETNA
TN3371161Medicaid
TN620819926OtherAETNA
TN4039349OtherAETNA
TNB03877Medicare UPIN
TN0723280003Medicare NSC
TN31798541Medicare PIN