Provider Demographics
NPI:1417963349
Name:TAYLOR, GRANT M (DO)
Entity Type:Individual
Prefix:DR
First Name:GRANT
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 MIRAMONT DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-1959
Mailing Address - Country:US
Mailing Address - Phone:970-556-8306
Mailing Address - Fax:
Practice Address - Street 1:1523 MIRAMONT DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-1959
Practice Address - Country:US
Practice Address - Phone:970-556-8306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00689871OtherRAILROAD MEDICARE
CO33707065Medicaid
COP00689871OtherRAILROAD MEDICARE
COCO301457Medicare PIN
COH61248Medicare UPIN