Healthcare Provider Details

I. General information

NPI: 1245214717
Provider Name (Legal Business Name): JEFFREY PATRICK TAYLOR D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

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 TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number1421
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: