Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 87-197 | NM |
NPI | 1225189145 |
---|---|
Provider Name | Mr. Tim C Taylor |
First Address | Addison, TX 75001-4625 |
Second Address | Santa Fe, NM 87505-7636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 28/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NM301542 | (02) | NM |