Healthcare Provider Details

I. General information

NPI: 1366436206
Provider Name (Legal Business Name): STEVER JOHN TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 N WASHINGTON ST
MEXICO MO
65265-2755
US

IV. Provider business mailing address

321 N WASHINGTON ST PO BOX 220
MEXICO MO
65265-2755
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-1129
  • Fax: 573-581-6994
Mailing address:
  • Phone: 573-581-1129
  • Fax: 573-581-6994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR7440
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: