Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DS021471L | PA |
NPI | 1003355280 |
---|---|
Provider Name | Dr. Lee Gifford Taylor SR. |
First Address | Havertown, PA 19083-3925 |
Second Address | Havertown, PA 19083-4606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2017 |
Last Update Date | 21/02/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1093873606 | NPI TYPE 2 (01) | PA |