Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 4301096709 | MI |
N | 208600000X | Surgeon | 4301096709 | MI |
Y | 2082S0105X | Plastic Hand Surgeon | 4301096709 | MI |
NPI | 1013111897 |
---|---|
Provider Name | Nathan Samuel Taylor |
First Address | Marquette, MI 49855-2675 |
Second Address | Marquette, MI 49855-2675 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2007 |
Last Update Date | 29/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0520253 | BLUE CROSS BLUE SHIELD MI (01) | MI |
1013111897 | (05) | MI |