Healthcare Provider Details

I. General information

NPI: 1275858094
Provider Name (Legal Business Name): JORDAN M. TAYLOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 W 8TH AVE
SPOKANE WA
99204-2307
US

IV. Provider business mailing address

PO BOX 94645
SEATTLE WA
98124-6945
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-3131
  • Fax:
Mailing address:
  • Phone: 509-474-3131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME123724
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD60650813
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: