Basic Information
| Provider Information | |||||||||
| NPI: | 1003092842 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DEVIN | ||||||||
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| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2927 N 7TH AVE | ||||||||
| Address2: | PEPPERTREE - FAMILY MEDICINE #3 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063153 | ||||||||
| FaxNumber: | 6024064122 | ||||||||
| Practice Location | |||||||||
| Address1: | 2927 N 7TH AVE | ||||||||
| Address2: | PEPPERTREE - FAMILY MEDICINE #3 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850134102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063153 | ||||||||
| FaxNumber: | 6024064122 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2008 | ||||||||
| LastUpdateDate: | 11/30/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R983 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | R983 | 01 | AZ | TRAINER PERMIT | OTHER |