Healthcare Provider Details

I. General information

NPI: 1376532309
Provider Name (Legal Business Name): JAY DANIEL TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 SUNSET BLVD
CONRAD MT
59425-1799
US

IV. Provider business mailing address

805 SUNSET BLVD P O BOX 758
CONRAD MT
59425-0758
US

V. Phone/Fax

Practice location:
  • Phone: 406-271-3231
  • Fax: 406-271-3576
Mailing address:
  • Phone: 406-271-3231
  • Fax: 406-271-3576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10678
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: