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NPI Code Detail

MEDICARE: DR. RICHARD LLWELLYN TAW JR. M.D.

MEDICARE: DR. RICHARD LLWELLYN TAW JR. M.D.
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
1174400000XSpecialistG26846CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G26848OTHERCALICENSE NUMBER

General Provider Information

NPI Number : 1255333407
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RICHARD LLWELLYN TAW JR. M.D.
Provider Business Mailing Address
First Line : 2021 SANTA MONICA BLVD
Second Line : STE 212E
City : SANTA MONICA
State : CA
Zip : 90404-2208
Country : US
Telephone Number : 310-829-4327
Fax Number : 310-453-4348
Provider Business Practice Location Address
First Line : 2021 SANTA MONICA BLVD
Second Line : STE 212E
City : SANTA MONICA
State : CA
Zip : 90404-2208
Country : US
Telephone Number : 310-829-4327
Fax Number : 310-453-4348
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 01/27/2010

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