Healthcare Provider Details

I. General information

NPI: 1477540896
Provider Name (Legal Business Name): JOHN KARL TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date: 03/21/2016
Reactivation Date: 04/08/2016

III. Provider practice location address

4062 FLYING C RD
CAMERON PARK CA
95682-9664
US

IV. Provider business mailing address

4062 FLYING C RD
CAMERON PARK CA
95682-9664
US

V. Phone/Fax

Practice location:
  • Phone: 530-676-8234
  • Fax: 530-676-0819
Mailing address:
  • Phone: 530-676-8234
  • Fax: 530-676-0819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberG036151
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: