Provider Demographics
NPI:1508841966
Name:TAYLOR, STEPHENS DAVIS (MD)
Entity Type:Individual
Prefix:
First Name:STEPHENS
Middle Name:DAVIS
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3649
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3649
Mailing Address - Country:US
Mailing Address - Phone:508-353-4941
Mailing Address - Fax:
Practice Address - Street 1:910 W 5TH AVE STE 900
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-2948
Practice Address - Country:US
Practice Address - Phone:509-838-2531
Practice Address - Fax:509-755-6580
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-02828208600000X
WA605949782086S0129X
MA2379572086S0129X
MI43010732332086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51553549Medicaid
WA2048867Medicaid
AL4045741OtherAETNA
AL515-16227OtherBLUE CROSS/BLUE SHIELD
ALA97144Medicare UPIN