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NPI Code Detail

MEDICARE: DR. CHAD ROBERT TAYLOR D.O.

MEDICARE: DR. CHAD ROBERT TAYLOR D.O.
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 Physician006644AZ

General Provider Information

NPI Number : 1871937417
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHAD ROBERT TAYLOR D.O.
Provider Business Mailing Address
First Line : PO BOX 35380
Second Line :
City : LAS VEGAS
State : NV
Zip : 89133-5380
Country : US
Telephone Number : 702-579-3203
Fax Number :
Provider Business Practice Location Address
First Line : 2001 N 4TH ST
Second Line :
City : FLAGSTAFF
State : AZ
Zip : 86004-4227
Country : US
Telephone Number : 928-527-4325
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2013
Last Update Date : 07/25/2024

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