Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 6394 | TX |
NPI | 1477765089 |
---|---|
Provider Name | Dr. Kenneth R. Taylor |
First Address | Dallas, TX 75248-1926 |
Second Address | Dallas, TX 75248-1926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 08/07/2007 |