Basic Information
| Provider Information | |||||||||
| NPI: | 1730157769 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | JON | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 820 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809010820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194480981 | ||||||||
| FaxNumber: | 7194480767 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652120001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738822568 | ||||||||
| FaxNumber: | 8559030985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2006 | ||||||||
| LastUpdateDate: | 09/12/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 38873 | CO | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 2021000511 | MO | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 200093015 | 05 | MO | MEDICAID | 050046959 | 01 | CO | RAILROAD MEDICARE NUMBER | OTHER | 63473364 | 05 | CO | MEDICAID |