Healthcare Provider Details

I. General information

NPI: 1447446315
Provider Name (Legal Business Name): THOMAS J. TAYLOR MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MISSION RIDGE RD
CORRALES NM
87048-6412
US

IV. Provider business mailing address

5080 SPECTRUM DR SUITE 1200 W
ADDISON TX
75001-4648
US

V. Phone/Fax

Practice location:
  • Phone: 505-898-9192
  • Fax:
Mailing address:
  • Phone: 972-725-6673
  • Fax: 214-775-4406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number2000-299
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: