Basic Information
| Provider Information | |||||||||
| NPI: | 1265455117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 W. MAIN ST. FREMONT RADIOLOGY | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 825013230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078566530 | ||||||||
| FaxNumber: | 3078567629 | ||||||||
| Practice Location | |||||||||
| Address1: | 1001 W MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | RIVERTON | ||||||||
| State: | WY | ||||||||
| PostalCode: | 825013230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3078566530 | ||||||||
| FaxNumber: | 3078567629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2006 | ||||||||
| LastUpdateDate: | 08/14/2019 | ||||||||
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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 | 2085N0904X | 5665A | WY | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0204X | 5665A | WY | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 2085U0001X | 5665A | WY | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound | 2085R0202X | 5665A | WY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 111321600 | 05 | WY | MEDICAID |