Basic Information
| Provider Information | |||||||||
| NPI: | 1184011413 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | KYLE | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10123 SE MARKET ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972162532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032516155 | ||||||||
| FaxNumber: | 5032616769 | ||||||||
| Practice Location | |||||||||
| Address1: | 10123 SE MARKET ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972162532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032516155 | ||||||||
| FaxNumber: | 5032616769 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2015 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 0101267473 | VA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208M00000X | 0101267473 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207P00000X | MD212925 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.