MEDICARE: DR. EDWARD TAXIN DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1378	AZ
2	207Q00000X	Family Medicine Physician	3791	CA

General Provider Information

NPI Number	:	1134113897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD TAXIN DO

Provider Business Mailing Address
First Line	:	3012 E GRANDVIEW ST
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-4231
Country	:	US
Telephone Number	:	480-219-4476
Fax Number	:	480-219-4898

Provider Business Practice Location Address
First Line	:	1492 SOUTH MILL AVENUE
Second Line	:	SUITE 312
City	:	TEMPE
State	:	AZ
Zip	:	85281-5676
Country	:	US
Telephone Number	:	602-243-7277
Fax Number	:	480-927-1092

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2005
Last Update Date	:	07/28/2015

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Directions to “ DR. EDWARD TAXIN DO” Practice Location

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