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General NPI Number Information
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NPI Number | 1306871090
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Entity Type | Individual
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Provider Name | MARTHA A TAYLOR MD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/14/2017
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Provider Practice Location Address
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Address Line | 1263 LAKE PLAZA DR SUITE 230
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3564
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Country | US
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Telephone | 719-776-3300
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Fax | 719-776-3329
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Provider Business Mailing Address
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Address Line | 1263 LAKE PLAZA DR SUITE 230
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-3564
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Country | US
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Telephone | 719-776-3300
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Fax | 719-776-3329
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01066927A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | DR.0055744
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 01066927A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 55744
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License Number State | CO
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