Provider Demographics
NPI:1902942089
Name:TAYLOR, FLETCHER BRANDON (MD)
Entity Type:Individual
Prefix:
First Name:FLETCHER
Middle Name:BRANDON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19410 HIGHWAY 99 STE A263
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5102
Mailing Address - Country:US
Mailing Address - Phone:253-212-3101
Mailing Address - Fax:253-212-3225
Practice Address - Street 1:19410 HIGHWAY 99 STE A263
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5102
Practice Address - Country:US
Practice Address - Phone:253-212-3101
Practice Address - Fax:253-212-3225
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000274722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE53883Medicare UPIN