Healthcare Provider Details

I. General information

NPI: 1235392580
Provider Name (Legal Business Name): MATTHEW ALAN TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 NW SAMARITAN DR
CORVALLIS OR
97330-3737
US

IV. Provider business mailing address

444 NW ELKS DRIVE
CORVALLIS OR
97330
US

V. Phone/Fax

Practice location:
  • Phone: 541-754-1276
  • Fax:
Mailing address:
  • Phone: 541-754-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301092764
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number4301092764
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD181955
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: