Provider Demographics
NPI:1083648877
Name:CYNTHIA L. TAYLOR, MD
Entity Type:Organization
Organization Name:CYNTHIA L. TAYLOR, MD
Other - Org Name:WHOLE FAMILY HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-244-5520
Mailing Address - Street 1:PO BOX 6989
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97228-6989
Mailing Address - Country:US
Mailing Address - Phone:206-439-4888
Mailing Address - Fax:206-242-7247
Practice Address - Street 1:14212 AMBAUM BLVD SW
Practice Address - Street 2:SUITE 106
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1449
Practice Address - Country:US
Practice Address - Phone:206-244-5520
Practice Address - Fax:206-957-0034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA00025830207Q00000X
WA00025830261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAF04592Medicare UPIN