Provider Demographics
NPI:1669605093
Name:TAYLOR, DAVID D (IDC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ATTN: MEDICAL
Mailing Address - Street 2:USS CARR (FFG 52)
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09566
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ATTN: MEDICAL
Practice Address - Street 2:USS CARR (FFG 52)
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09566
Practice Address - Country:US
Practice Address - Phone:757-445-6160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-02
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman