Healthcare Provider Details

I. General information

NPI: 1306871090
Provider Name (Legal Business Name): MARTHA A TAYLOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1263 LAKE PLAZA DR SUITE 230
COLORADO SPRINGS CO
80906-3564
US

IV. Provider business mailing address

1263 LAKE PLAZA DR SUITE 230
COLORADO SPRINGS CO
80906-3564
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-3300
  • Fax: 719-776-3329
Mailing address:
  • Phone: 719-776-3300
  • Fax: 719-776-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01066927A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDR.0055744
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01066927A
License Number StateIN
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55744
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: