Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | A154495 | CA |
N | 207P00000X | Emergency Physician | DR.0056331 | CO |
NPI | 1003158791 |
---|---|
Provider Name | Dr. Taylor Wilson Burkholder |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2013 |
Last Update Date | 17/10/2018 |