Provider Demographics
NPI:1629041264
Name:TAYLOR, MARLEY
Entity Type:Individual
Prefix:DR
First Name:MARLEY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:853 MIDDLEFIELD RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-2920
Mailing Address - Country:US
Mailing Address - Phone:650-323-1300
Mailing Address - Fax:650-323-3301
Practice Address - Street 1:853 MIDDLEFIELD RD
Practice Address - Street 2:SUITE 3
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-2920
Practice Address - Country:US
Practice Address - Phone:650-323-1300
Practice Address - Fax:650-323-3301
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2010-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3426213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000E34260Medicare ID - Type Unspecified
CAT11682Medicare UPIN