Healthcare Provider Details

I. General information

NPI: 1083940704
Provider Name (Legal Business Name): GEOFFREY TAYLOR, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 W MEMORIAL RD SUITE 703
OKLAHOMA CITY OK
73120-9350
US

IV. Provider business mailing address

4200 W MEMORIAL RD SUITE 703
OKLAHOMA CITY OK
73120-9350
US

V. Phone/Fax

Practice location:
  • Phone: 405-755-1080
  • Fax: 405-751-8923
Mailing address:
  • Phone: 405-755-1080
  • Fax: 405-751-8923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number24414
License Number StateOK

VIII. Authorized Official

Name: DR. GEOFFREY TAYLOR
Title or Position: PRESIDENT
Credential:
Phone: 405-755-1080