Healthcare Provider Details

I. General information

NPI: 1356906440
Provider Name (Legal Business Name): TAYLOR POPE BASKIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2019
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 RENFERT WAY STE 250
AUSTIN TX
78758-5657
US

IV. Provider business mailing address

12221 RENFERT WAY STE 250
AUSTIN TX
78758-5657
US

V. Phone/Fax

Practice location:
  • Phone: 512-814-8255
  • Fax:
Mailing address:
  • Phone: 512-814-8255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberU3154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: