Individual
MARK TABOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2120 EXCHANGE ST, SUITE 111, ASTORIA, OR 97103-3365
(503) 325-0333
Mailing address
PO BOX 96, BORING, OR 97009-0096
(503) 325-0333
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00726
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218105
—
OR
01
—
840126019
REGENCE BS/BC
OR
05
—
8441354
—
WA
01
—
P00087890
RR MC
OR
Enumeration date
12/23/2005
Last updated
07/06/2016
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