Provider Demographics
NPI:1275927014
Name:DEREK A TAGGARD MD A PROF CORP
Entity Type:Organization
Organization Name:DEREK A TAGGARD MD A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:
Authorized Official - Last Name:TAGGARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-733-8247
Mailing Address - Street 1:2801 K ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5120
Mailing Address - Country:US
Mailing Address - Phone:916-733-8247
Mailing Address - Fax:916-781-2001
Practice Address - Street 1:2801 K ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5120
Practice Address - Country:US
Practice Address - Phone:916-733-8247
Practice Address - Fax:916-781-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80229207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty