Provider Demographics
NPI:1083643472
Name:TAYLOR, RICHARD CHARLES (CPED)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:CHARLES
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 SW APPLE WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1783
Mailing Address - Country:US
Mailing Address - Phone:503-493-3668
Mailing Address - Fax:503-460-3338
Practice Address - Street 1:8225 SW APPLE WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1783
Practice Address - Country:US
Practice Address - Phone:503-493-3668
Practice Address - Fax:503-460-3338
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10616174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR276134Medicaid
OR5039750001Medicare ID - Type UnspecifiedMEDICARE