Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | R5645 | MO |
NPI | 1053334797 |
---|---|
Provider Name | Philip W Taylor |
First Address | Kansas City, MO 64184-3225 |
Second Address | Cape Girardeau, MO 63703-5056 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 03/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1053334797 | (05) | IL |
173594 | HEALTHLINK (01) | |
201877826 | (05) | MO |
603522 | ANTHEM BCBS (01) | MO |
A13135 | (02) | MO |
P00779931 | RR MCR (01) | MO |