Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | DR.0061712 | CO |
N | 207W00000X | Ophthalmologist | MD182284 | OR |
NPI | 1013250240 |
---|---|
Provider Name | Stanford Connolly Taylor |
First Address | Colorado Springs, CO 80909-1183 |
Second Address | Colorado Springs, CO 80909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2013 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1013250240 | (05) | CO |