Healthcare Provider Details

I. General information

NPI: 1518915693
Provider Name (Legal Business Name): DOUGLAS M TAYLOR DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 06/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 SAN MIGUEL DR SUITE 30
WALNUT CREEK CA
94596-5279
US

IV. Provider business mailing address

1855 SAN MIGUEL DR SUITE 30
WALNUT CREEK CA
94596-5279
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-7796
  • Fax: 925-945-7652
Mailing address:
  • Phone: 925-945-7796
  • Fax: 925-945-7652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberE3216
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberE3216
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberE3216
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE3216
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: