=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467577437
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY MARSHALL TAFF M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43850 BUCKHORN COVE RD EAST
-----------------------------------------------------
City | LITTLE RIVER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95456-0458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-937-3686
-----------------------------------------------------
Fax | 707-937-1117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 458 43850 BUCKHORN COVE RD EAST
-----------------------------------------------------
City | LITTLE RIVER
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95456-0458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-937-3686
-----------------------------------------------------
Fax | 707-937-1117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | G34755
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------