Individual
CHARLES PAUL TABOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 999-1911
Mailing address
1601 GOLF COURSE RD, GRAND RAPIDS, MN 55744-8648
(218) 786-3146
(218) 725-2620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1740719640
MN
390200000X
Student in an Organized Health Care Education/Training Program
64365
MN
Other
Enumeration date
06/06/2017
Last updated
11/12/2021
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