Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 51784071205 | UT |
N | 207R00000X | Internist | 2011018390 | MO |
N | 111NI0900X | Internist | 2011018390 | MO |
N | 207RC0000X | Internist - Cardiovascular Disease | M12933 | ID |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | M-12933 | ID |
NPI | 1033123658 |
---|---|
Provider Name | Matthew G Taylor |
First Address | Coeur D Alene, ID 83814-2656 |
Second Address | Coeur D Alene, ID 83814-2656 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 27/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H73671 | (02) | UT |