Provider Demographics
NPI:1528409471
Name:TAYLOR, MARK B (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:B
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:440 W 200 S STE 250
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-1462
Mailing Address - Country:US
Mailing Address - Phone:801-595-1600
Mailing Address - Fax:801-364-0423
Practice Address - Street 1:440 W 200 S
Practice Address - Street 2:SUITE 250
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1345
Practice Address - Country:US
Practice Address - Phone:801-595-1600
Practice Address - Fax:801-364-0423
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-08
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT158056-1205207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology