Healthcare Provider Details

I. General information

NPI: 1831195007
Provider Name (Legal Business Name): THOMAS L TAYLOR D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date: 03/20/2006
Reactivation Date: 04/13/2006

III. Provider practice location address

401 WESTPARK WAY
EULESS TX
76040-3957
US

IV. Provider business mailing address

401 WESTPARK WAY
EULESS TX
76040-3957
US

V. Phone/Fax

Practice location:
  • Phone: 817-283-5151
  • Fax: 817-283-8360
Mailing address:
  • Phone: 817-283-5151
  • Fax: 817-283-8360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberTX518
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberTX518
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: