Provider Demographics
NPI:1356384929
Name:TAYLOR, KORI H (DPM)
Entity type:Individual
Prefix:
First Name:KORI
Middle Name:H
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6717 N OAK TRFY
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64118-3346
Mailing Address - Country:US
Mailing Address - Phone:816-452-1211
Mailing Address - Fax:816-452-4211
Practice Address - Street 1:6717 N OAK TRFY
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64118-3346
Practice Address - Country:US
Practice Address - Phone:816-452-1211
Practice Address - Fax:816-452-4211
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000701213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U53218Medicare UPIN