Provider Demographics
NPI:1205584588
Name:TABBAL, JEAN ELIE (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN ELIE
Middle Name:
Last Name:TABBAL
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 1:417 BUCK JONES RD
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27606-1203
Mailing Address - Country:US
Mailing Address - Phone:984-212-3113
Mailing Address - Fax:
Practice Address - Street 1:4309 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2388
Practice Address - Country:US
Practice Address - Phone:919-668-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2022-00474207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine