Provider Demographics
NPI:1447216254
Name:TAYLOR, BRANDON DEAN (DOM)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:DEAN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1279 SENDA DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-7181
Mailing Address - Country:US
Mailing Address - Phone:505-438-2646
Mailing Address - Fax:505-986-6005
Practice Address - Street 1:204 N GUADALUPE ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-1827
Practice Address - Country:US
Practice Address - Phone:505-988-4357
Practice Address - Fax:505-986-6005
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM883171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist