Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | 2007001647 | MO |
NPI | 1093012460 |
---|---|
Provider Name | Ernest Lee Taylor |
First Address | Cape Girardeau, MO 63701-5230 |
Second Address | Cape Girardeau, MO 63701-5230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2011 |
Last Update Date | 22/02/2011 |