Basic Information
Provider Information | |||||||||
NPI: | 1730364159 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | TAYLOR | ||||||||
FirstName: | JEFFERY | ||||||||
MiddleName: | KARL | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 5502 W SAINT FRANCIS CIR | ||||||||
Address2: |   | ||||||||
City: | LOOMIS | ||||||||
State: | CA | ||||||||
PostalCode: | 956507917 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9164124512 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 10535 HOSPITAL WAY | ||||||||
Address2: | DEPARTMENT OF ORTHOPEDIC SURGERY, SACRAMENTO VAMC | ||||||||
City: | MATHER | ||||||||
State: | CA | ||||||||
PostalCode: | 956554200 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9168437000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 01/03/2008 | ||||||||
LastUpdateDate: | 07/23/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | A44816 | CA | Y |   | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery |
No ID Information.