Provider Demographics
NPI:1598767113
Name:TABER, JEFFREY DAVID (MD)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:DAVID
Last Name:TABER
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 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:591 2ND AVE N
Practice Address - Street 2:
Practice Address - City:WINDOM
Practice Address - State:MN
Practice Address - Zip Code:56101-1927
Practice Address - Country:US
Practice Address - Phone:507-831-2223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN33708207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN135203200Medicaid
MNNA3221016530OtherPREFERRED ONE
MN1506584OtherIA MEDICAID
MN112159OtherUCARE MINNESOTA
MN33246WIOtherBLUE CROSS BLUE SHIELD