Provider Demographics
NPI:1225303159
Name:LIES, TAYLOR M (PA-C)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:M
Last Name:LIES
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:106 RIDGEWATER DR STE A
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-8977
Mailing Address - Country:US
Mailing Address - Phone:406-883-3200
Mailing Address - Fax:406-883-9483
Practice Address - Street 1:106 RIDGEWATER DR STE A
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-8977
Practice Address - Country:US
Practice Address - Phone:406-883-3200
Practice Address - Fax:406-883-9483
Is Sole Proprietor?:No
Enumeration Date:2012-03-10
Last Update Date:2023-11-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MT15504363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical