Provider Demographics
NPI:1710011143
Name:TAYLOR, KEITH J
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2401 WATERMAN BLVD
Mailing Address - Street 2:STE 4A
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94534-1800
Mailing Address - Country:US
Mailing Address - Phone:707-290-0627
Mailing Address - Fax:
Practice Address - Street 1:1035 SAN PABLO AVE
Practice Address - Street 2:STE 8
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2275
Practice Address - Country:US
Practice Address - Phone:510-559-2000
Practice Address - Fax:707-429-1129
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist