Provider Demographics
NPI:1386987295
Name:TAYLOR, EVA (MD)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:LONGBINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:22620 SE 4TH STREET
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22620 SE 4TH STREET
Practice Address - Street 2:SUITE #200
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074
Practice Address - Country:US
Practice Address - Phone:425-836-5407
Practice Address - Fax:425-836-5557
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA132486208000000X
390200000X
WAMD.60637474208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program