Basic Information
| Provider Information | |||||||||
| NPI: | 1508841966 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | STEPHENS | ||||||||
| MiddleName: | DAVIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3649 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992203649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083534941 | ||||||||
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| Practice Location | |||||||||
| Address1: | 910 W 5TH AVE STE 900 | ||||||||
| Address2: | |||||||||
| City: | SPOKANE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 992042948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5098382531 | ||||||||
| FaxNumber: | 5097556580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 05/03/2017 | ||||||||
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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 | 2086S0129X | 237957 | MA | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 4301073233 | MI | N | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | 2086S0129X | 60594978 | WA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
| ID | Type | State | Issuer | Description | 51553549 | 05 | AL | MEDICAID | 515-16227 | 01 | AL | BLUE CROSS/BLUE SHIELD | OTHER | 4045741 | 01 | AL | AETNA | OTHER |