Provider Demographics
NPI:1609868264
Name:TAYLOR, DENISE ADELE (MD)
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:ADELE
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1916
Mailing Address - Country:US
Mailing Address - Phone:503-873-8686
Mailing Address - Fax:503-873-8689
Practice Address - Street 1:335 FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:SILVERTON
Practice Address - State:OR
Practice Address - Zip Code:97381-1916
Practice Address - Country:US
Practice Address - Phone:503-873-8686
Practice Address - Fax:503-873-8689
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2012-05-16
Deactivation Date:2006-03-21
Deactivation Code:
Reactivation Date:2006-04-03
Provider Licenses
StateLicense IDTaxonomies
TXJ8800207Q00000X
ORMD27185207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR271301Medicaid
ORG67982Medicare UPIN
OR00388GMedicare PIN