Provider Demographics
NPI:1457363590
Name:TARBOX, MICHAEL JOSEPH (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:TARBOX
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1755 US ROUTE 6 W
Mailing Address - Street 2:
Mailing Address - City:ROULETTE
Mailing Address - State:PA
Mailing Address - Zip Code:16746-1025
Mailing Address - Country:US
Mailing Address - Phone:814-544-3182
Mailing Address - Fax:814-544-3184
Practice Address - Street 1:1755 US ROUTE 6 W
Practice Address - Street 2:
Practice Address - City:ROULETTE
Practice Address - State:PA
Practice Address - Zip Code:16746-1025
Practice Address - Country:US
Practice Address - Phone:814-544-3182
Practice Address - Fax:814-544-3184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005851213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA122869JT3OtherMEDICARE ID