Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 2002002156 | MO |
NPI | 1023083011 |
---|---|
Provider Name | Dr. Brett A Taylor |
First Address | Ballwin, MO 63011-3657 |
Second Address | Ballwin, MO 63011 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 26/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G59245 | (02) | MO |