Individual
TAVIS J TAYLOR
Active
Individual
TAVIS J TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
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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