Provider Demographics
NPI:1346215209
Name:TABOR, OWEN B JR (MD)
Entity type:Individual
Prefix:
First Name:OWEN
Middle Name:B
Last Name:TABOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6077 PRIMACY PKWY STE 140
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-5742
Mailing Address - Country:US
Mailing Address - Phone:901-725-8347
Mailing Address - Fax:901-259-7637
Practice Address - Street 1:1244 PRIMACY PKWY
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-0201
Practice Address - Country:US
Practice Address - Phone:901-767-8662
Practice Address - Fax:901-259-2785
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN31462207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4179728OtherBCBS
TN7468367OtherAETNA
TN620819926OtherAETNA
TN620819926OtherCIGNA
TN31462OtherLICENSE
TN9675413OtherCIGNA
TNP00620731OtherRAILROAD MEDICARE
TN00001906041 05OtherUNITED HEALTHCARE
TN3371161Medicaid
TN2031OtherABOS
TN3839229Medicaid
TN3839229Medicaid
MS07187860Medicaid
TN00001906041 05OtherUNITED HEALTHCARE
TN7468367OtherAETNA
TNP00620731OtherRAILROAD MEDICARE
TN0723280003Medicare NSC