Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 4301092764 | MI |
N | 207QS0010X | Family Doctor - Sports Medicine | 4301092764 | MI |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD181955 | OR |
NPI | 1235392580 |
---|---|
Provider Name | Matthew Alan Taylor |
First Address | Corvallis, OR 97330 |
Second Address | Corvallis, OR 97330-3737 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2008 |
Last Update Date | 13/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500728926 | (05) | OR |