Healthcare Provider Details

I. General information

NPI: 1033448741
Provider Name (Legal Business Name): GARY N TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 05/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1118 TUSCAN SKY LN #101
HENDERSON NV
89002-0647
US

IV. Provider business mailing address

1118 TUSCAN SKY LN #101
HENDERSON NV
89002-0647
US

V. Phone/Fax

Practice location:
  • Phone: 702-566-9454
  • Fax: 702-566-9455
Mailing address:
  • Phone: 702-566-9454
  • Fax: 702-566-9455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number154855-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: