Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208800000X | Urologist | M5782 | ID |
NPI | 1033121322 |
---|---|
Provider Name | Dr. Timothy Osborn Taylor |
First Address | Idaho Falls, ID 83404-4957 |
Second Address | Idaho Falls, ID 83404-7407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2006 |
Last Update Date | 15/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000012701 | CMS NORIDIAN ADM SERVICES (01) | UT |
0004082 | BLUE SHIELD (01) | ID |
1033121322 | (02) | ID |
804289600 | (05) | ID |
DI379 | BLUE CROSS (01) | ID |