Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 0101271283 | VA |
Y | 207N00000X | Dermatologist | 64080 | AZ |
N | 208D00000X | General Practice Physician | MD.31138 | AL |
NPI | 1023338241 |
---|---|
Provider Name | Dr. Bradley Michael Taylor |
First Address | Flagstaff, AZ 86001-1383 |
Second Address | Cottonwood, AZ 86326-4125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2010 |
Last Update Date | 12/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
098262 | (05) | AZ |