Provider Demographics
NPI:1295741866
Name:TABOR, TIMOTHY BRET (MD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:BRET
Last Name:TABOR
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 1:820 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5223
Mailing Address - Country:US
Mailing Address - Phone:256-549-0008
Mailing Address - Fax:256-549-0401
Practice Address - Street 1:1699 GOLDEN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-7097
Practice Address - Country:US
Practice Address - Phone:256-835-0835
Practice Address - Fax:256-835-1939
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL000215682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051551974Medicaid
G42965Medicare UPIN
AL051551974Medicaid