Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 16796 | TX |
NPI | 1205810801 |
---|---|
Provider Name | Dr. Jay Stephen Taylor |
First Address | Peterson Afb, CO 80914-1540 |
Second Address | Peterson Afb, CO 80914-1540 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 29/03/2018 |