Healthcare Provider Details

I. General information

NPI: 1477547586
Provider Name (Legal Business Name): HERBERT TYLER TAYLOR III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 TRINITY DR STE B3
LOS ALAMOS NM
87544-2221
US

IV. Provider business mailing address

3500TRINITY DR STE B3
LOS ALAMOS NM
87544-2221
US

V. Phone/Fax

Practice location:
  • Phone: 505-661-2411
  • Fax: 505-662-7216
Mailing address:
  • Phone: 505-661-2411
  • Fax: 505-662-7216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2000-298
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: