Individual
TABOR DAVID DIZON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
80 SEYMOUR STREET, HARTFORD HOSPITAL CRITICAL CARE MEDICINE, HARTFORD, CT 06102-5037
(860) 545-5200
Mailing address
P.O. BOX 415933, HARTFORD HOSPITAL PROFESSIONAL SERVICES, BOSTON, MA 02241-5933
(860) 545-7602
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
002519
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003025194
—
CT
Enumeration date
11/16/2010
Last updated
02/16/2012
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