Basic Information
| Provider Information | |||||||||
| NPI: | 1831119676 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAIT | ||||||||
| FirstName: | LAUREL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3880 MAJESTIC OAKS DR | ||||||||
| Address2: | |||||||||
| City: | OXFORD | ||||||||
| State: | MS | ||||||||
| PostalCode: | 386558143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6622367070 | ||||||||
| FaxNumber: | 6622367078 | ||||||||
| Practice Location | |||||||||
| Address1: | 106 HIGHWAY 62 W | ||||||||
| Address2: | |||||||||
| City: | SALEM | ||||||||
| State: | AR | ||||||||
| PostalCode: | 725768059 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8708952015 | ||||||||
| FaxNumber: | 8708952164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213EP1101X | MO00556 | MO | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist | Primary Podiatric Medicine |
ID Information
| ID | Type | State | Issuer | Description | 480005007 | 01 | MO | RAILROAD MEDICARE | OTHER | 12934038 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER | 02358739 | 05 | MS | MEDICAID |