Provider Demographics
NPI:1972508505
Name:TAYLOR, PAMELA ANN (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:ANN
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 1:6011 E WOODMEN RD
Mailing Address - Street 2:STE 120
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-2603
Mailing Address - Country:US
Mailing Address - Phone:719-776-8500
Mailing Address - Fax:719-634-1448
Practice Address - Street 1:6011 E WOODMEN RD
Practice Address - Street 2:STE 120
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2603
Practice Address - Country:US
Practice Address - Phone:719-776-8500
Practice Address - Fax:719-634-1448
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0030681207R00000X
CO30681207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP01025201OtherMCR RAILROAD
CO01306810Medicaid
COCOAAA3638Medicare UPIN
CO01306810Medicaid
E70857Medicare UPIN