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General NPI Number Information
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NPI Number | 1275927014
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Entity Type | Organization
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Legal Business Name | DEREK A TAGGARD MD A PROF CORP
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Dates
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Enumeration Date | 03/18/2015
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Last Update Date | 03/18/2015
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Provider Practice Location Address
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Address Line | 2801 K ST SUITE 410
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City | SACRAMENTO
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State | CA
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Zip | 95816-5120
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Country | US
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Telephone | 916-733-8247
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Fax | 916-781-2001
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Provider Business Mailing Address
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Address Line | 2801 K ST SUITE 410
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City | SACRAMENTO
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State | CA
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Zip | 95816-5120
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Country | US
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Telephone | 916-733-8247
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Fax | 916-781-2001
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Authorized Official
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Title or Position | MD/OWNER
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Name | DEREK TAGGARD
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Credential | MD
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Telephone | 916-733-8247
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | A80229
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License Number State | CA
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