=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609868264
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE ADELE TAYLOR MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2005
-----------------------------------------------------
Last Update Date | 05/16/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 335 FAIRVIEW ST
-----------------------------------------------------
City | SILVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97381-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-873-8686
-----------------------------------------------------
Fax | 503-873-8689
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 335 FAIRVIEW ST
-----------------------------------------------------
City | SILVERTON
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97381-1916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-873-8686
-----------------------------------------------------
Fax | 503-873-8689
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | J8800
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | MD27185
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------