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General NPI Number Information
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NPI Number | 1568718674
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Entity Type | Individual
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Provider Name | DONALD TAIT DO
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Gender | Male
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 162 LEGACY OAKS DR
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City | KNIGHTDALE
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State | NC
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Zip | 27545-6556
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Country | US
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Telephone | 919-373-1810
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Fax |
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Provider Business Mailing Address
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Address Line | 162 LEGACY OAKS DR STE 101
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City | KNIGHTDALE
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State | NC
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Zip | 27545-6557
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Country | US
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Telephone | 919-620-4855
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Fax |
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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 | 34.011554
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A-1939-16
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License Number State | NM
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 2020-00625
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License Number State | NC
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