Provider Demographics
NPI:1275544520
Name:TAYLOR, ALAN B (CRNA)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:B
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 BLANCA AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2340
Mailing Address - Country:US
Mailing Address - Phone:719-589-2511
Mailing Address - Fax:719-587-1372
Practice Address - Street 1:106 BLANCA AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2340
Practice Address - Country:US
Practice Address - Phone:719-589-2511
Practice Address - Fax:719-587-1372
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5180725-4406367500000X
CO5203367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT68295OtherPEHP
UT219509OtherALTIUS
UT508823OtherHEALTHY U
UT190246100OtherUS DEPT OF LABOR
UTTPRA07482OtherMOLINA
UT005780212Medicare ID - Type Unspecified
UT508823OtherHEALTHY U
UTP74501Medicare UPIN