Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 01066927A | IN |
Y | 207Q00000X | Family Doctor | 55744 | CO |
N | 207QS0010X | Family Doctor - Sports Medicine | 01066927A | IN |
N | 207QS0010X | Family Doctor - Sports Medicine | DR.0055744 | CO |
NPI | 1306871090 |
---|---|
Provider Name | Martha A Taylor |
First Address | Colorado Springs, CO 80906-3564 |
Second Address | Colorado Springs, CO 80906-3564 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 14/08/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201007900 | (05) | IN |