Healthcare Provider Details

I. General information

NPI: 1205974326
Provider Name (Legal Business Name): PAUL J TAYOUN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S CHURCH ST SUITE B
HAZLETON PA
18201-6279
US

IV. Provider business mailing address

101 S CHURCH ST SUITE B
HAZLETON PA
18201-6279
US

V. Phone/Fax

Practice location:
  • Phone: 570-501-1017
  • Fax: 570-501-2695
Mailing address:
  • Phone: 570-501-1017
  • Fax: 570-501-2695

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS007636L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0012696090010
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier0012696090006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: