Provider Demographics
NPI:1568486660
Name:TAYLOR, DENNIS L
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:DENNIS
Other - Middle Name:LEE
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:578 RIO LINDO AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-1800
Mailing Address - Country:US
Mailing Address - Phone:530-894-6195
Mailing Address - Fax:530-894-6199
Practice Address - Street 1:578 RIO LINDO AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95926-1800
Practice Address - Country:US
Practice Address - Phone:530-894-6195
Practice Address - Fax:530-894-6199
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3004213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E30041Medicaid
CA1256070001Medicare NSC
CAT11548Medicare UPIN
CA000E30040Medicare PIN