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1588727846

NPI Code Detail

MEDICARE: DR. KEVIN W TAGGART MD

MEDICARE: DR. KEVIN W TAGGART 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	207Q00000X	Family Medicine Physician	MD00036453	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	930079954	OTHER	WA	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5920661	OTHER	WA	AETNA
2	8937586	OTHER	WA	L&I CRIME
3	0128732	OTHER	WA	LABOR AND INDUSTRIES
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	TA6989	OTHER	WA	REGENCE RIDER

General Provider Information

NPI Number	:	1588727846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN W TAGGART MD

Provider Business Mailing Address
First Line	:	3908 10TH ST SE
Second Line	:
City	:	PUYALLUP
State	:	WA
Zip	:	98374-2188
Country	:	US
Telephone Number	:	253-848-5951
Fax Number	:	253-845-7073

Provider Business Practice Location Address
First Line	:	611 31ST AVE SW
Second Line	:	STE. C
City	:	PUYALLUP
State	:	WA
Zip	:	98373-3723
Country	:	US
Telephone Number	:	253-848-5951
Fax Number	:	253-845-7073

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

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	01/25/2016

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Directions to “ DR. KEVIN W TAGGART MD” Practice Location

Language	Start Address	Practice Location

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