Healthcare Provider Details

I. General information

NPI: 1780667790
Provider Name (Legal Business Name): DOUGLAS SCOTT TAYLOR MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 12/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2521 STOCKTON BLVD PEDS HEM/ONC CLINIC, 3RD FLOOR
SACRAMENTO CA
95817-2207
US

IV. Provider business mailing address

2516 STOCKTON BLVD TICON II, 3RD FLOOR
SACRAMENTO CA
95817-2208
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-2781
  • Fax: 916-734-1357
Mailing address:
  • Phone: 916-734-2781
  • Fax: 916-451-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberG085352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: