Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 00008631 | AL |
NPI | 1144285156 |
---|---|
Provider Name | Dr. Kenneth K Taylor |
First Address | Montgomery, AL 36117 |
Second Address | Montgomery, AL 36117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C75527 | (02) | |
C75527 | (02) | AL |