Provider Demographics
NPI:1477547586
Name:TAYLOR, HERBERT TYLER III (MD)
Entity Type:Individual
Prefix:
First Name:HERBERT
Middle Name:TYLER
Last Name:TAYLOR
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3500TRINITY DR
Mailing Address - Street 2:STE B3
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2221
Mailing Address - Country:US
Mailing Address - Phone:505-661-2411
Mailing Address - Fax:505-662-7216
Practice Address - Street 1:3500 TRINITY DR
Practice Address - Street 2:STE B3
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2221
Practice Address - Country:US
Practice Address - Phone:505-661-2411
Practice Address - Fax:505-662-7216
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM2000-298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2000-298OtherSTATE PROFESSIONAL LICENS
NM206749OtherSTATE CONTROLLED SUBSTANC
NMAT8652376OtherDEA REGISTRATION
NM2000-298OtherSTATE PROFESSIONAL LICENS
NMBO9134Medicare UPIN