Individual
DR. TIMOTHY OSBORN TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2330 CORONADO ST, IDAHO FALLS, ID 83404-7407
(208) 552-1234
(208) 522-9580
Mailing address
8893 SADDLEHORN, IDAHO FALLS, ID 83404-4957
(208) 523-6750
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
M5782
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000012701
CMS NORIDIAN ADM SERVICES
UT
01
—
0004082
BLUE SHIELD
ID
05
—
804289600
—
ID
01
—
DI379
BLUE CROSS
ID
Enumeration date
08/13/2006
Last updated
01/15/2012
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