Healthcare Provider Details

I. General information

NPI: 1780189076
Provider Name (Legal Business Name): TAYLOR HART
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14300 ORCHARD PKWY FL 1
WESTMINSTER CO
80023-9206
US

IV. Provider business mailing address

2801 N ROCK RD APT 910
WICHITA KS
67226-1183
US

V. Phone/Fax

Practice location:
  • Phone: 303-430-5560
  • Fax:
Mailing address:
  • Phone: 785-477-0320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number207Q00000X
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberPENDING
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: