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Individual

DR. MARK D TABER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1520 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3408
(636) 497-4055
Mailing address
1520 WENTZVILLE PKWY, WENTZVILLE, MO 63385-3408
(636) 497-4055

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036062673
IL
207RC0000X
Cardiovascular Disease Physician
R9F84
MO
207RI0011X
Interventional Cardiology Physician
R9F84
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
202265807
MO
Enumeration date
03/28/2006
Last updated
09/03/2024
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