Provider Demographics
NPI:1013556422
Name:TAYLOR, KEITH GORDON
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:GORDON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9045 S 1300 E
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-3134
Mailing Address - Country:US
Mailing Address - Phone:801-666-6834
Mailing Address - Fax:801-904-0272
Practice Address - Street 1:179 W WINCHESTER ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7237
Practice Address - Country:US
Practice Address - Phone:801-904-3826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker