1780667790 NPI number — DR. DOUGLAS SCOTT TAYLOR MD, PHD

Table of content: DR. DOUGLAS SCOTT TAYLOR MD, PHD (NPI 1780667790)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780667790 NPI number — DR. DOUGLAS SCOTT TAYLOR MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
DOUGLAS
Provider Middle Name:
SCOTT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780667790
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2516 STOCKTON BLVD
Provider Second Line Business Mailing Address:
TICON II, 3RD FLOOR
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95817-2208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-734-2781
Provider Business Mailing Address Fax Number:
916-451-3014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2521 STOCKTON BLVD
Provider Second Line Business Practice Location Address:
PEDS HEM/ONC CLINIC, 3RD FLOOR
Provider Business Practice Location Address City Name:
SACRAMENTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95817-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-734-2781
Provider Business Practice Location Address Fax Number:
916-734-1357
Provider Enumeration Date:
11/23/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , with the licence number:  G085352 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com