Provider Demographics
NPI:1932268778
Name:TABLER, JAMES B (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:TABLER
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 1:6225 W. HWY. 146, STE 1
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014
Mailing Address - Country:US
Mailing Address - Phone:502-822-3499
Mailing Address - Fax:502-822-1564
Practice Address - Street 1:6225 W. HWY 146, STE 1
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014
Practice Address - Country:US
Practice Address - Phone:502-822-3499
Practice Address - Fax:502-822-1564
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY248562084P0800X
IN01042201A2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50065924OtherPASSPORT HEALTH PLAN
IN100357460AMedicaid
KY64248560Medicaid
KY0576210Medicare ID - Type Unspecified
KYF98247Medicare UPIN
KY64248560Medicaid