Healthcare Provider Details

I. General information

NPI: 1649699737
Provider Name (Legal Business Name): DOUGLAS FRANCIS TAYLOR D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2014
Last Update Date: 07/29/2020
Certification Date: 07/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG/FFNM20 101 BODIN CIR
TRAVIS AFB CA
94535-1800
US

IV. Provider business mailing address

60 MDG/FFNM20 101 BODIN CIRCLE
TRAVIS AIR FORCE BASE CA
94535-1800
US

V. Phone/Fax

Practice location:
  • Phone: 210-313-1759
  • Fax:
Mailing address:
  • Phone: 210-313-1759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0102204388
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number0102204388
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: