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General NPI Number Information
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NPI Number | 1164455259
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Entity Type | Organization
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Legal Business Name | MICHAEL K TAYLOR, MD, & JASON T HALVERSON, MD, PLLC
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 04/24/2023
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Provider Practice Location Address
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Address Line | 261 CANYON CREST DR STE 100
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City | TWIN FALLS
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State | ID
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Zip | 83301-5924
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Country | US
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Telephone | 208-733-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 261 CANYON CREST DR STE 100
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City | TWIN FALLS
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State | ID
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Zip | 83301-5924
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Country | US
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Telephone | 208-733-5300
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JASON T HALVERSON
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Credential | MD
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Telephone | 208-733-5300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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