Individual
DR. BRENT ERIC TABOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
702 RUSSELL AVE, SUITE 103, GAITHERSBURG, MD 20877-2606
(301) 948-3668
Mailing address
702 RUSSELL AVE, SUITE 103, GAITHERSBURG, MD 20877-2606
(301) 948-3668
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
01195
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218838400
—
MD
Enumeration date
12/19/2005
Last updated
02/06/2020
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