Provider Demographics
NPI:1043297815
Name:TAYLER, GREGORY P (MD, PC)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:P
Last Name:TAYLER
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1469 S HIGHWAY 40 # C
Mailing Address - Street 2:
Mailing Address - City:HEBER CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84032-3522
Mailing Address - Country:US
Mailing Address - Phone:435-654-3535
Mailing Address - Fax:435-654-2853
Practice Address - Street 1:1469 S HIGHWAY 40 # C
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-3522
Practice Address - Country:US
Practice Address - Phone:435-654-3535
Practice Address - Fax:435-654-2853
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT324399-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT$$$$$$$$$036Medicaid
UT$$$$$$$$$036Medicaid
UTG34789Medicare UPIN