Healthcare Provider Details

I. General information

NPI: 1407817026
Provider Name (Legal Business Name): BRUCE D TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 06/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
COLUMBIA MO
65201-5276
US

IV. Provider business mailing address

PO BOX 7687
COLUMBIA MO
65205-7687
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-2568
  • Fax: 573-882-2226
Mailing address:
  • Phone: 573-882-2568
  • Fax: 573-882-2226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberE4711
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: