Provider Demographics
NPI:1194036566
Name:TAYLOR, THOMAS ROBERT ALDEN (DO)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ROBERT ALDEN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:T.
Other - Middle Name:ROBERT
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:3811 E BELL RD STE 107
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2158
Mailing Address - Country:US
Mailing Address - Phone:602-482-6100
Mailing Address - Fax:602-992-6424
Practice Address - Street 1:3811 E BELL RD STE 107
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2158
Practice Address - Country:US
Practice Address - Phone:602-482-6100
Practice Address - Fax:602-992-6424
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ005964207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine