Healthcare Provider Details

I. General information

NPI: 1477451805
Provider Name (Legal Business Name): MR. JASON MIRON TAYLOR SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2026
Last Update Date: 10/27/2026
Certification Date: 10/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4265 45TH ST S STE 137
FARGO ND
58104-4326
US

IV. Provider business mailing address

8100 PENN AVE S STE 124
BLOOMINGTON MN
55431-1319
US

V. Phone/Fax

Practice location:
  • Phone: 701-237-9977
  • Fax:
Mailing address:
  • Phone: 612-500-7832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberH-0467
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHID-1028
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: