Healthcare Provider Details

I. General information

NPI: 1902892102
Provider Name (Legal Business Name): MICHAEL ASHLEY TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 STANYAN ST ST. MARY'S MEDICAL CENTER DEPT. OF RADIOLOGY RM114-A
SAN FRANCISCO CA
94117-1079
US

IV. Provider business mailing address

39 VIA NAVARRO
GREENBRAE CA
94904-1215
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-5770
  • Fax:
Mailing address:
  • Phone: 415-377-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA83022
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME72100
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: