Individual
MR. JEFFREY DAVID TABER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
591 2ND AVE N, WINDOM, MN 56101-1927
(507) 831-2223
Mailing address
PO BOX 5074, SIOUX FALLS, SD 57117-5074
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
33708
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112159
UCARE MINNESOTA
MN
05
—
135203200
—
MN
01
—
1506584
IA MEDICAID
MN
01
—
33246WI
BLUE CROSS BLUE SHIELD
MN
01
—
NA3221016530
PREFERRED ONE
MN
Enumeration date
08/12/2005
Last updated
12/12/2024
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