Provider Demographics
NPI:1073753570
Name:TAYLOR, DESHAWN (MD)
Entity Type:Individual
Prefix:
First Name:DESHAWN
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 685
Mailing Address - Street 2:NONE
Mailing Address - City:WADDELL
Mailing Address - State:AZ
Mailing Address - Zip Code:85355
Mailing Address - Country:US
Mailing Address - Phone:480-447-8857
Mailing Address - Fax:
Practice Address - Street 1:1526 W GLENDALE AVE
Practice Address - Street 2:SUITE 109
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-8576
Practice Address - Country:US
Practice Address - Phone:480-447-8857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV14659207VG0400X
AZ41803207VG0400X
CAA83243207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology