Basic Information
| Provider Information | |||||||||
| NPI: | 1780189076 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | HART | ||||||||
| FirstName: | TAYLOR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2801 N ROCK RD APT 910 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672261183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854770320 | ||||||||
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| Practice Location | |||||||||
| Address1: | 14300 ORCHARD PKWY FL 1 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800239206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034305560 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 11/05/2019 | ||||||||
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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 | 207Q00000X | 207Q00000X | CO | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | PENDING | CO | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.