Basic Information
| Provider Information | |||||||||
| NPI: | 1164431672 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4230 E PONTATOC CANYON DR | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857185233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202978518 | ||||||||
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| Practice Location | |||||||||
| Address1: | 77 W FOREST AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | FLAGSTAFF | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 860011479 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287732505 | ||||||||
| FaxNumber: | 9287732504 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 08/04/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 23743 | AZ | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 349870 | 05 | AZ | MEDICAID |