1811992555 NPI number — DR. MARK A TAYLOR O.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811992555 NPI number — DR. MARK A TAYLOR O.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

TAYLOR

Provider First Name:

MARK

Provider Middle Name:

A

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

O.D.

Provider Gender Code:

M

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:

1811992555

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

01/15/2020

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 792

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

KAYSVILLE

Provider Business Mailing Address State Name:

UT

Provider Business Mailing Address Postal Code:

84037-0792

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

801-774-8707

Provider Business Mailing Address Fax Number:

801-774-8784

Provider First Line Business Practice Location Address:

128 N MAIN ST

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

KAYSVILLE

Provider Business Practice Location Address State Name:

UT

Provider Business Practice Location Address Postal Code:

84037-1951

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

801-543-2525

Provider Business Practice Location Address Fax Number:

801-593-1982

Provider Enumeration Date:

06/17/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 152W00000X , with the licence number:  345066-9934 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 141851557 . This is a "MAILHANDLERS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 1472285 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: GRP108096200 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
• Identifier: 349783 . This is a "DESERET MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 570526286TA1 . This is a "EDUCATORS MUTUAL" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 364806 . This is a "USA MANAGED CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 141851887 . This is a "PEHP" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 14237 . This is a "RIO GRANDE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 2068338 . This is a "FIRST HEALTH" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 2200211 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".
• Identifier: 141851557 . This is a "TRICARE" identifier , issued by the state of ( UT ) . This identifiers is of the category "OTHER".