Provider Demographics
NPI:1023338241
Name:TAYLOR, BRADLEY MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:MICHAEL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1490 N TURQUOISE DR
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1383
Mailing Address - Country:US
Mailing Address - Phone:928-774-5074
Mailing Address - Fax:928-779-0884
Practice Address - Street 1:297 S WILLARD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4125
Practice Address - Country:US
Practice Address - Phone:928-639-9596
Practice Address - Fax:928-639-0189
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101271283207N00000X
AZ64080207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ098262Medicaid