1588727846 NPI number — DR. KEVIN W TAGGART MD

Table of content: DR. KEVIN W TAGGART MD (NPI 1588727846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588727846 NPI number — DR. KEVIN W TAGGART MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAGGART
Provider First Name:
KEVIN
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1588727846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3908 10TH ST SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PUYALLUP
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98374-2188
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-848-5951
Provider Business Mailing Address Fax Number:
253-845-7073

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 31ST AVE SW
Provider Second Line Business Practice Location Address:
STE. C
Provider Business Practice Location Address City Name:
PUYALLUP
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98373-3723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-848-5951
Provider Business Practice Location Address Fax Number:
253-845-7073
Provider Enumeration Date:
12/18/2006

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: 207Q00000X , with the licence number:  MD00036453 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5920661 . This is a "AETNA" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8937586 . This is a "L&I CRIME" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 0128732 . This is a "LABOR AND INDUSTRIES" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8240970 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: TA6989 . This is a "REGENCE RIDER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 930079954 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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