Provider Demographics
NPI:1770515579
Name:TAYLOR, MARK (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3718 BRIAR PATH
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-1323
Mailing Address - Country:US
Mailing Address - Phone:712-258-9073
Mailing Address - Fax:712-258-9073
Practice Address - Street 1:3718 BRIAR PATH
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-1323
Practice Address - Country:US
Practice Address - Phone:712-258-9073
Practice Address - Fax:712-258-9073
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA01622207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine