Provider Demographics
NPI:1023083011
Name:TAYLOR, BRETT A (MD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:884 WOODS MILL RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3657
Mailing Address - Country:US
Mailing Address - Phone:636-227-8226
Mailing Address - Fax:
Practice Address - Street 1:884 WOODS MILL RD
Practice Address - Street 2:SUITE 201
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011
Practice Address - Country:US
Practice Address - Phone:636-227-8226
Practice Address - Fax:636-686-9194
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2002002156207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOG59245Medicare UPIN