Individual
DR. EMMANUEL JUANE TABORA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
525 N EASTOWN RD, SUITE A, LIMA, OH 45807-2268
(419) 224-4646
(419) 224-2410
Mailing address
951 COMMERCE PKWY, SUITE 101, LIMA, OH 45804-4040
(419) 998-4575
(419) 998-4586
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35.036923
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000527468
ANTHEM BCBS
OH
05
—
0551924
—
OH
01
—
1538113253
ANTHEM BCBS
OH
Enumeration date
05/19/2006
Last updated
11/04/2014
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