Provider Demographics
NPI:1134286115
Name:JEFFREY TABER MD
Entity type:Organization
Organization Name:JEFFREY TABER MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:507-831-2550
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:WINDOM
Mailing Address - State:MN
Mailing Address - Zip Code:56101-0187
Mailing Address - Country:US
Mailing Address - Phone:507-831-2550
Mailing Address - Fax:507-831-5528
Practice Address - Street 1:2170 HOSPITAL DR STE A
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1287
Practice Address - Country:US
Practice Address - Phone:507-831-2550
Practice Address - Fax:507-831-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN33246WIOtherBCBS - GROUP
MN993813300Medicaid