Provider Demographics
NPI:1861409252
Name:TAYLOR, GARRETT R (MD)
Entity type:Individual
Prefix:
First Name:GARRETT
Middle Name:R
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:PO BOX 5045
Mailing Address - Street 2:ATTN: PROV ENROLLMENT, P.F.S.
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-2000
Mailing Address - Fax:605-322-2036
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-2000
Practice Address - Fax:605-322-2036
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD5195207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN106K1TAOtherMN BC PROVIDER #
SD6004660Medicaid
IA1550228Medicaid
MN607620300Medicaid
SDP00920439OtherRAILROAD MEDICARE
SC9216564OtherDAKOTACARE PROVIDER #
SD0041368OtherSDBC P ROVIDER #
NE46022474331Medicaid
SDP00046387OtherRR MEDICARE PROVIDER #
NE46022474331Medicaid
SC9216564OtherDAKOTACARE PROVIDER #