Provider Demographics
NPI:1932246931
Name:TAYLOR, DONALD H (PA-C)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:H
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 129
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89041-0129
Mailing Address - Country:US
Mailing Address - Phone:775-727-7800
Mailing Address - Fax:775-727-7808
Practice Address - Street 1:1401 S HIGHWAY 160
Practice Address - Street 2:SUITE B
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-4784
Practice Address - Country:US
Practice Address - Phone:775-727-7800
Practice Address - Fax:775-727-7808
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV555363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV555OtherMEDICAL LICENSE
NV555OtherMEDICAL LICENSE