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General NPI Number Information
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NPI Number | 1619985579
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Entity Type | Individual
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Provider Name | BILL TAYLOR TERRY MD
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Gender | Male
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 07/15/2011
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Provider Practice Location Address
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Address Line | 408 22ND AVE S
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City | NAMPA
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State | ID
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Zip | 83651-5424
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Country | US
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Telephone | 208-866-5365
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Fax | 208-939-8801
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Provider Business Mailing Address
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Address Line | PO BOX 44450
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City | BOISE
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State | ID
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Zip | 83711-0450
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Country | US
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Telephone | 208-322-1001
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Fax | 208-939-8801
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | M-5594
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | M-5594
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License Number State | ID
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