Healthcare Provider Details

I. General information

NPI: 1073577946
Provider Name (Legal Business Name): CHARLES LANE TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR EVANS ARMY COMMUNITY HOSPITAL
FT CARSON CO
80913-4613
US

IV. Provider business mailing address

2401 PARKVIEW BLVD
COLORADO SPRINGS CO
80906-1159
US

V. Phone/Fax

Practice location:
  • Phone: 701-526-7000
  • Fax:
Mailing address:
  • Phone: 719-331-9366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number20360
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: