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General NPI Number Information
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NPI Number | 1578732137
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Entity Type | Organization
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Legal Business Name | CRESTWOOD MEDICAL GROUP INC
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 47 CRESTWOOD RD STE #2
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City | KAYSVILLE
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State | UT
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Zip | 84037-1445
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Country | US
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Telephone | 801-546-1273
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Fax | 801-546-1631
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Provider Business Mailing Address
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Address Line | 47 CRESTWOOD RD STE #2 CRESTWOOD MEDICAL GROUP
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City | KAYSVILLE
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State | UT
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Zip | 84037-1445
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Country | US
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Telephone | 801-546-1273
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Fax | 801-546-1631
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. JOHN B TAYLOR
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Credential | MD
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Telephone | 801-546-1273
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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 | 161981-1205
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License Number State | UT
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