MEDICARE: MARTHA A TAYLOR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01066927A	IN
2	207QS0010X	Sports Medicine (Family Medicine) Physician	DR.0055744	CO
3	207QS0010X	Sports Medicine (Family Medicine) Physician	01066927A	IN
4	207Q00000X	Family Medicine Physician	55744	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306871090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA A TAYLOR MD

Provider Business Mailing Address
First Line	:	1263 LAKE PLAZA DR
Second Line	:	SUITE 230
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3564
Country	:	US
Telephone Number	:	719-776-3300
Fax Number	:	719-776-3329

Provider Business Practice Location Address
First Line	:	1263 LAKE PLAZA DR
Second Line	:	SUITE 230
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3564
Country	:	US
Telephone Number	:	719-776-3300
Fax Number	:	719-776-3329

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/14/2017

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Directions to “ MARTHA A TAYLOR MD” Practice Location

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