| Doctor Name: | TIMOTHY MICHAEL TABOR |
| NPI Number: | 1013012756 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | |
| Business Practice Address: | 3800 Lexington Ave N Shoreview, MN - 551262916 |
| Business Phone Number: | 6514860048 |
| Business Fax Number: | 6514902600 |
| Mailing Address: | 180 Colleen Ave, SHOREVIEW |
| State: | MN |
| Postal Code: | 551266201 |
| Phone Number: | 3179469542 |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |