Provider Demographics
NPI:1992383160
Name:CAMMACK, TAYLOR LAINE (DO)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:LAINE
Last Name:CAMMACK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:TAYLOR
Other - Middle Name:LAINE
Other - Last Name:ERNEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8383 W ALAMEDA AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3007
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN72288207Q00000X
MN31581207Q00000X
CODR.0072847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029481OtherKAISER COMMERCIAL NUMBER