Provider Demographics
NPI:1588727846
Name:TAGGART, KEVIN W (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:W
Last Name:TAGGART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3908 10TH ST SE
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98374-2188
Mailing Address - Country:US
Mailing Address - Phone:253-848-5951
Mailing Address - Fax:253-845-7073
Practice Address - Street 1:611 31ST AVE SW
Practice Address - Street 2:STE. C
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3723
Practice Address - Country:US
Practice Address - Phone:253-848-5951
Practice Address - Fax:253-845-7073
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00036453207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5920661OtherAETNA
WA8937586OtherL&I CRIME
WA0128732OtherLABOR AND INDUSTRIES
WA8240970Medicaid
WATA6989OtherREGENCE RIDER
WA930079954OtherMEDICARE RAILROAD
WATA6989OtherREGENCE RIDER