Provider Demographics
NPI:1700332186
Name:TAYLOR, DUSTIN EUGENE
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:EUGENE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9849 17TH AVE SW # 127
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-2714
Mailing Address - Country:US
Mailing Address - Phone:206-295-0427
Mailing Address - Fax:
Practice Address - Street 1:9849 17TH AVE SW # 127
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-2714
Practice Address - Country:US
Practice Address - Phone:206-295-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60592315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist