Individual
OWEN B. TABOR JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1244 PRIMACY PKWY, MEMPHIS, TN 38119-0201
(901) 767-8662
(901) 259-2785
Mailing address
6077 PRIMACY PKWY STE 140, MEMPHIS, TN 38119-5742
(901) 725-8347
(901) 259-7637
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
31462
TN
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
31462
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00001906041 05
UNITED HEALTHCARE
TN
01
—
2031
ABOS
TN
01
—
31462
LICENSE
TN
05
—
3371161
—
TN
05
—
3839229
—
TN
01
—
4179728
BCBS
TN
01
—
620819926
AETNA
TN
01
—
7468367
AETNA
TN
01
—
9675413
CIGNA
TN
01
—
P00620731
RAILROAD MEDICARE
TN
Enumeration date
02/22/2006
Last updated
04/02/2021
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