Healthcare Provider Details

I. General information

NPI: 1245339761
Provider Name (Legal Business Name): THOMAS TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 E GREEN ST #214
PASADENA CA
91106-2401
US

IV. Provider business mailing address

960 E GREEN ST #214
PASADENA CA
91106-2401
US

V. Phone/Fax

Practice location:
  • Phone: 626-577-7730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG66279
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: