Provider Demographics
NPI:1881087443
Name:TABORA, TYSON JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:TYSON
Middle Name:JOSEPH
Last Name:TABORA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12989 SOUTHERN BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9291
Mailing Address - Country:US
Mailing Address - Phone:561-809-2343
Mailing Address - Fax:888-491-0775
Practice Address - Street 1:12989 SOUTHERN BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9291
Practice Address - Country:US
Practice Address - Phone:561-809-2343
Practice Address - Fax:888-491-0775
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3687213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1881087443OtherINDIVIDIAL NPI NUMBER