Provider Demographics
NPI:1699146233
Name:TAYLOR, DYLAN
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W 2640 S
Mailing Address - Street 2:
Mailing Address - City:PRICE
Mailing Address - State:UT
Mailing Address - Zip Code:84501-4469
Mailing Address - Country:US
Mailing Address - Phone:435-580-9143
Mailing Address - Fax:
Practice Address - Street 1:305 CENTER STREET
Practice Address - Street 2:
Practice Address - City:EAST CARBON
Practice Address - State:UT
Practice Address - Zip Code:84520
Practice Address - Country:US
Practice Address - Phone:435-888-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6052291-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant