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NPI Code Detail

MEDICARE: MARK TAYLOR DO

MEDICARE:   MARK  TAYLOR  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
1207Q00000XFamily Medicine Physician01622IA

General Provider Information

NPI Number : 1770515579
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK TAYLOR DO
Provider Business Mailing Address
First Line : 3718 BRIAR PATH
Second Line :
City : SIOUX CITY
State : IA
Zip : 51104-1323
Country : US
Telephone Number : 712-258-9073
Fax Number : 712-258-9073
Provider Business Practice Location Address
First Line : 3718 BRIAR PATH
Second Line :
City : SIOUX CITY
State : IA
Zip : 51104-1323
Country : US
Telephone Number : 712-258-9073
Fax Number : 712-258-9073
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2006
Last Update Date : 02/15/2008

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Directions to “ MARK TAYLOR DO” Practice Location

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