Provider Demographics
NPI:1104807635
Name:PAIGE, TAMON BERBER (MD)
Entity type:Individual
Prefix:DR
First Name:TAMON
Middle Name:BERBER
Last Name:PAIGE
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:PO BOX 2526
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-2526
Mailing Address - Country:US
Mailing Address - Phone:417-347-7600
Mailing Address - Fax:
Practice Address - Street 1:5265 S BUSINESS 71
Practice Address - Street 2:STE A
Practice Address - City:PINEVILLE
Practice Address - State:MO
Practice Address - Zip Code:65865
Practice Address - Country:US
Practice Address - Phone:417-223-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO1166592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203871215Medicaid
KS100379890CMedicaid
OK100180840AMedicaid
MOP00819884OtherRAIL ROAD MEDICARE
MO203871215Medicaid
MOP00819884OtherRAIL ROAD MEDICARE