1598741902 NPI number — DR. LAURENCE EDWARD TAYLOR DO

Table of content: DR. LAURENCE EDWARD TAYLOR DO (NPI 1598741902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598741902 NPI number — DR. LAURENCE EDWARD TAYLOR DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TAYLOR
Provider First Name:
LAURENCE
Provider Middle Name:
EDWARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1598741902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 WOODLAND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOS BAY
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97420-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-267-5151
Provider Business Mailing Address Fax Number:
541-266-4501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
94180 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLD BEACH
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97444-8733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-247-7047
Provider Business Practice Location Address Fax Number:
541-247-0123
Provider Enumeration Date:
12/16/2005

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: 207Q00000X , with the licence number:  DO12821 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207P00000X , with the licence number: DO12821 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1407812365 . This is a "NBMC GROUP NPI NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: CB3544 . This is a "RR MEDICARE GROUP NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 227421 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: R0000WFBTV . This is a "MEDICARE GROUP PIN NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 080167069 . This is a "RR MEDICARE PTAN NUMBER" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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