Basic Information
| Provider Information | |||||||||
| NPI: | 1114023124 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | ELMO | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1477 NORTH 2000 WEST | ||||||||
| Address2: | WESTSIDE MEDICAL | ||||||||
| City: | CLINTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017748888 | ||||||||
| FaxNumber: | 8018258519 | ||||||||
| Practice Location | |||||||||
| Address1: | 1477 NORTH 2000 WEST | ||||||||
| Address2: | WESTSIDE MEDICAL | ||||||||
| City: | CLINTON | ||||||||
| State: | UT | ||||||||
| PostalCode: | 84015 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8017748888 | ||||||||
| FaxNumber: | 8018258519 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 10/13/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1025541206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.