Basic Information
| Provider Information | |||||||||
| NPI: | 1578776241 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TABEREAUX | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | BYRON | ||||||||
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| Credential: | MD, MPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 04/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 26602 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0001X | 26602 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology |
ID Information
| ID | Type | State | Issuer | Description | P00746293 | 01 | AL | RAILROAD MEDICARE | OTHER | 510-48687 | 01 | AL | BCBS | OTHER | 112153 | 05 | AL | MEDICAID | 510-49313 | 01 | AL | BCBS | OTHER | 510-49314 | 01 | AL | BCBS | OTHER | 110103 | 05 | AL | MEDICAID | 112142 | 05 | AL | MEDICAID | 515-99689 | 01 | AL | BCBS | OTHER | 112152 | 05 | AL | MEDICAID | 515-99692 | 01 | AL | BCBS | OTHER | 112150 | 05 | AL | MEDICAID | 510-48688 | 01 | AL | BCBS | OTHER | 515-99691 | 01 | AL | BCBS | OTHER | 112146 | 05 | AL | MEDICAID | 112154 | 05 | AL | MEDICAID | 510-49312 | 01 | AL | BCBS | OTHER |