Provider Demographics
NPI:1316117880
Name:GREGORY P TAYLER MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:GREGORY P TAYLER MD PROFESSIONAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D., P.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAYLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-654-3535
Mailing Address - Street 1:1469 S HIGHWAY 40 # C
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3522
Mailing Address - Country:US
Mailing Address - Phone:435-654-3535
Mailing Address - Fax:435-654-2853
Practice Address - Street 1:1469 S HIGHWAY 40 # C
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3522
Practice Address - Country:US
Practice Address - Phone:435-654-3535
Practice Address - Fax:435-654-2853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT963243991205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1043297815OtherREGENCE
UT529338064036Medicaid
UT1043297815OtherSELECTHEALTH
UT1043297815OtherREGENCE