Provider Demographics
NPI:1134362395
Name:TAYLOR, JEROD LEE (IDMT)
Entity type:Individual
Prefix:MR
First Name:JEROD
Middle Name:LEE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:211 ARNOLD AVE STE 15
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-2111
Mailing Address - Country:US
Mailing Address - Phone:541-885-6140
Mailing Address - Fax:541-885-6608
Practice Address - Street 1:211 ARNOLD AVE STE 15
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-2111
Practice Address - Country:US
Practice Address - Phone:541-885-6140
Practice Address - Fax:541-885-6608
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians