MEDICARE: DR. ZACK C TAYLOR MD

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	2086S0129X	Vascular Surgery Physician	45776	AZ
2	208600000X	Surgery Physician	77524	AZ
3	2086S0129X	Vascular Surgery Physician	64044	TN

General Provider Information

NPI Number	:	1437321411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ZACK C TAYLOR MD

Provider Business Mailing Address
First Line	:	2911 N SANTA ANA LN
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85749-9236
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 E SILVER ST
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85719-3153
Country	:	US
Telephone Number	:	520-694-6000
Fax Number	:

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

Provider Enumeration Date	:	03/30/2008
Last Update Date	:	11/17/2021

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