MEDICARE: DR. TAYLOR ANDREW PATTERSON 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	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	010491	AZ

General Provider Information

NPI Number	:	1316576093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAYLOR ANDREW PATTERSON DO

Provider Business Mailing Address
First Line	:	10230 W HAPPY VALLEY PKWY STE 100
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-4692
Country	:	US
Telephone Number	:	623-561-3030
Fax Number	:	623-825-5630

Provider Business Practice Location Address
First Line	:	10230 W HAPPY VALLEY PKWY UNIT 100-200
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85383-4691
Country	:	US
Telephone Number	:	623-561-3030
Fax Number	:

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

Provider Enumeration Date	:	04/05/2020
Last Update Date	:	09/19/2023

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