Provider Demographics
NPI:1720097231
Name:TABOR, DAVID C (DO)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:C
Last Name:TABOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2093 HEALTH DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WYOMING
Mailing Address - State:MI
Mailing Address - Zip Code:49519
Mailing Address - Country:US
Mailing Address - Phone:616-452-7099
Mailing Address - Fax:616-452-4142
Practice Address - Street 1:2093 HEALTH DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519
Practice Address - Country:US
Practice Address - Phone:616-452-7099
Practice Address - Fax:616-452-4142
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2009-07-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine