Provider Demographics
NPI:1720377484
Name:TAYLOR, BRANDON C (MD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:C
Last Name:TAYLOR
Suffix:
Gender:M
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:PO BOX # 2010
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-2010
Mailing Address - Country:US
Mailing Address - Phone:970-945-7564
Mailing Address - Fax:970-945-0563
Practice Address - Street 1:1906 BLAKE AVENUE
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601
Practice Address - Country:US
Practice Address - Phone:970-945-7564
Practice Address - Fax:970-945-0563
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
CAA1756402085R0202X
CODR.00630172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No174400000XOther Service ProvidersSpecialist