Provider Demographics
NPI:1679789002
Name:TABER, BROOKS (MD)
Entity type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:
Last Name:TABER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5220 GREENS DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-4612
Mailing Address - Country:US
Mailing Address - Phone:919-781-1437
Mailing Address - Fax:
Practice Address - Street 1:3200 BLUE RIDGE RD STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-8087
Practice Address - Country:US
Practice Address - Phone:919-781-1437
Practice Address - Fax:919-787-4870
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-006132085R0202X
VA01012705682085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology