Provider Demographics
NPI:1225189145
Name:TAYLOR, TIM C (MD)
Entity Type:Individual
Prefix:MR
First Name:TIM
Middle Name:C
Last Name:TAYLOR
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Gender:M
Credentials:MD
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Mailing Address - Street 1:5080 SPECTRUM DRIVE
Mailing Address - Street 2:SUITE 1200 WEST
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-4625
Mailing Address - Country:US
Mailing Address - Phone:972-364-8000
Mailing Address - Fax:214-775-4502
Practice Address - Street 1:720 SAINT MICHAELS DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7636
Practice Address - Country:US
Practice Address - Phone:505-438-9402
Practice Address - Fax:505-471-9240
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2009-05-28
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Provider Licenses
StateLicense IDTaxonomies
NM87-197204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMB0002Medicare PIN
NMNM301542Medicare UPIN