Basic Information
| Provider Information | |||||||||
| NPI: | 1134113897 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAXIN | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3012 E GRANDVIEW ST | ||||||||
| Address2: | |||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852134231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4802194476 | ||||||||
| FaxNumber: | 4802194898 | ||||||||
| Practice Location | |||||||||
| Address1: | 1492 SOUTH MILL AVENUE | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | TEMPE | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852815676 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022437277 | ||||||||
| FaxNumber: | 4809271092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2005 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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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 | 207Q00000X | 1378 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 3791 | CA | N | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.