Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 1364 | NV |
Y | 207P00000X | Emergency Physician | 4184 | AZ |
N | 207PE0004X | Emergency Medical Services | 1364 | NV |
NPI | 1003908195 |
---|---|
Provider Name | Jason Lamar Taylor |
First Address | Kingman, AZ 86401-7806 |
Second Address | Winslow, AZ 86047-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 14/08/2009 |