Healthcare Provider Details

I. General information

NPI: 1831867522
Provider Name (Legal Business Name): DUSTIN TAYLOR MED, LAT, ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 W COAL AVE
HOBBS NM
88240-1716
US

IV. Provider business mailing address

907 W COAL AVE
HOBBS NM
88240-1716
US

V. Phone/Fax

Practice location:
  • Phone: 505-412-9977
  • Fax:
Mailing address:
  • Phone: 505-412-9977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-2024-0011
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: