Provider Demographics
NPI:1770689911
Name:TAYLOR, JOHN SCOTT (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:SCOTT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:971 11TH LANE FI
Mailing Address - Street 2:
Mailing Address - City:FOX ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98333-9643
Mailing Address - Country:US
Mailing Address - Phone:253-238-0567
Mailing Address - Fax:
Practice Address - Street 1:407 14TH AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98372-3770
Practice Address - Country:US
Practice Address - Phone:253-697-1848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301074254207P00000X
MI074254207PE0004X
WAMD00048095207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B51090OtherBLUE SHIELD
MI104441890Medicaid
MI4786075Medicaid
MI4786075Medicaid
MI0B51090OtherBLUE SHIELD
MI104441890Medicaid