Healthcare Provider Details

I. General information

NPI: 1124019914
Provider Name (Legal Business Name): NEAL ROBERT TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 02/24/2025
Certification Date: 02/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 BALMER ST
HILL AFB UT
84056-5012
US

IV. Provider business mailing address

1644 N 150 E
LAYTON UT
84041-2412
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-1163
  • Fax:
Mailing address:
  • Phone: 409-996-1751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD052678L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: