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General NPI Number Information
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NPI Number | 1659113975
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Entity Type | Organization
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Legal Business Name | UROLOGY CLINIC
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Dates
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Enumeration Date | 06/07/2024
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Last Update Date | 08/06/2024
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Provider Practice Location Address
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Address Line | 875 S VANGUARD WAY STE 200D
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City | MERIDIAN
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State | ID
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Zip | 83642-8540
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Country | US
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Telephone | 208-782-6730
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Fax |
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Provider Business Mailing Address
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Address Line | 4186 W PINE MEADOWS DR
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City | EAGLE
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State | ID
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Zip | 83616-4785
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Country | US
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Telephone | 208-991-6232
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Fax |
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Authorized Official
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Title or Position | UROLOGIST
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Name | DR. MICHAEL BINNS TAYLOR
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Credential | MD
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Telephone | 208-991-6232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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