Healthcare Provider Details
I. General information
NPI: 1871290288
Provider Name (Legal Business Name): TAYLOR G WRIGHT PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/15/2023
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:
III. Provider practice location address
27B TALISMAN DR UNIT 2
PAGOSA SPRINGS CO
81147-7914
US
IV. Provider business mailing address
6405 S 3000 E STE 300
SALT LAKE CITY UT
84121-6977
US
V. Phone/Fax
- Phone: 970-903-9853
- Fax: 970-616-6745
- Phone: 801-266-3113
- Fax: 801-266-5633
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 213ES0103X |
| Taxonomy | Foot & Ankle Surgery Podiatrist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 332B00000X |
| Taxonomy | Durable Medical Equipment & Medical Supplies |
| License Number | |
| License Number State | |
| # 3 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363A00000X |
| Taxonomy | Physician Assistant |
| License Number | |
| License Number State | |
| # 4 | |
| Primary Taxonomy | N |
| Taxonomy Code | 363L00000X |
| Taxonomy | Nurse Practitioner |
| License Number | |
| License Number State | |
| # 5 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 213E00000X |
| Taxonomy | Podiatrist |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
TAYLOR
G
WRIGHT
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 801-266-3113