Taylor, Brandon Mark

Taylor, Brandon Mark is an individual health care provider with primary practice located at 4740 N Penngrove Way Ste 210 , Meridian ID 83646-7447. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Taylor, Brandon Mark can be contacted via phone (208) 514-0203.

Contact Information

Primary practice address
4740 N Penngrove Way Ste 210 Meridian ID 83646-7447
Phone: (208) 514-0203
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X O0725 Idaho

Profile Details

NPI number 1285855106
LBN Legal business name Taylor, Brandon Mark
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date May 1st, 2007
Last updated May 19th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285855106 NPPES
Nebraska MEDICAID 36331415914

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