Healthcare Provider Details

I. General information

NPI: 1457596629
Provider Name (Legal Business Name): SCOTT M TAYLOR MD PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 05/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 29TH ST SUITE #400
OAKLAND CA
94609-3522
US

IV. Provider business mailing address

400 29TH ST SUITE #400
OAKLAND CA
94609-3522
US

V. Phone/Fax

Practice location:
  • Phone: 510-238-9600
  • Fax: 510-238-9609
Mailing address:
  • Phone: 510-238-9600
  • Fax: 510-238-9609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA42745
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA42745
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberA42745
License Number StateCA

VIII. Authorized Official

Name: DR. SCOTT MORRIS TAYLOR
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 510-238-9600