Individual
LAURA A TABOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1880 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4315
(208) 524-6633
(208) 524-9952
Mailing address
1880 JOHN ADAMS PKWY, IDAHO FALLS, ID 83401-4315
(208) 524-6633
(208) 524-9952
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA415
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010027582
REGENCE BLUESHIELD GROUP
ID
01
—
000010156316
REGENCE BLUE SHIELD
ID
01
—
1134140148
BAKER FAMILY GROUP NPI
ID
05
—
806887600
—
ID
05
—
807659300
—
ID
01
—
8K123
BLUE CROSS GROUP
ID
01
—
DE1614
RAILROAD MCR GROUP
ID
01
—
P00205234
RAILROAD MEDICARE NUMBER
ID
01
—
PAC63
BLUE CROSS PROVIDER NUMBE
ID
Enumeration date
04/05/2006
Last updated
07/19/2010
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