Healthcare Provider Details

I. General information

NPI: 1497807051
Provider Name (Legal Business Name): WILLIAM SCOTT TAYLOR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/06/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 33100 BOX LANDSTUHL
APO AE
09180-3100
US

IV. Provider business mailing address

22323 CHIMAYO BND
SAN ANTONIO TX
78258-4331
US

V. Phone/Fax

Practice location:
  • Phone: 210-201-5043
  • Fax:
Mailing address:
  • Phone: 210-201-5043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11444
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: