Provider Demographics
NPI:1083726160
Name:TAYLOR, RANDY (MD,PHD)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7851 S ELATI ST STE 102
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-8081
Mailing Address - Country:US
Mailing Address - Phone:303-798-1309
Mailing Address - Fax:303-798-2319
Practice Address - Street 1:7851 S ELATI ST STE 102
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8081
Practice Address - Country:US
Practice Address - Phone:303-798-1309
Practice Address - Fax:303-798-2319
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COI59688Medicare UPIN