Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | E3216 | CA |
N | 111NR0200X | Radiology | E3216 | CA |
N | 213ER0200X | Radiology | E3216 | CA |
N | 2081S0010X | Sports Medicine | E3216 | CA |
N | 213ES0000X | Sports Medicine | E3216 | CA |
N | 213ES0103X | Foot & Ankle Surgery | E3216 | CA |
NPI | 1518915693 |
---|---|
Provider Name | Dr. Douglas M Taylor |
First Address | Walnut Creek, CA 94596-5279 |
Second Address | Walnut Creek, CA 94596-5279 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 28/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11582 | (02) | CA |