Individual
TAVIS J TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3036 PERRY AVE, SUITE A, BREMERTON, WA 98310-5349
(360) 627-8493
(360) 627-7920
Mailing address
3036 PERRY AVE, SUITE A, BREMERTON, WA 98310-5349
(360) 627-8493
(360) 627-7920
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00030507
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
128813
LABOR & INDUSTRIES
WA
01
—
263080490
KPS HEALTHPLANS
WA
05
—
8241556
—
WA
01
—
91114366509
KPS HEALTHPLANS
WA
01
—
91114366598310A009
TRICARE
WA
01
—
TA7118
REGENCE
WA
Enumeration date
10/04/2005
Last updated
04/08/2021
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