Healthcare Provider Details

I. General information

NPI: 1669834487
Provider Name (Legal Business Name): CHRISTOPHER CLANCY TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE STE 5017
COLORADO SPRINGS CO
80907-6865
US

IV. Provider business mailing address

2222 N NEVADA AVE STE 5017
COLORADO SPRINGS CO
80907-6865
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-6810
  • Fax: 719-776-6820
Mailing address:
  • Phone: 719-776-6810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0068005
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberDR.0068005
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: