Healthcare Provider Details

I. General information

NPI: 1144278052
Provider Name (Legal Business Name): ROBERT W. TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 07/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10333 EL CAMINO REAL
ATASCADERO CA
93422-5808
US

IV. Provider business mailing address

1600 9TH STREET, ROOM 150 FISCAL ALLOCATIONS AND ESTIMATES UNIT
SACRAMENTO CA
95814-6414
US

V. Phone/Fax

Practice location:
  • Phone: 805-468-2000
  • Fax: 805-468-6011
Mailing address:
  • Phone: 916-651-9475
  • Fax: 916-651-8908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberC38810
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00C388100
Identifier TypeMEDICAID
Identifier StateCA
Identifier Issuer
# 2
Identifier930106261
Identifier TypeOTHER
Identifier StateCA
Identifier IssuerMEDICARE RAILROAD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: