Individual
DEREK J. TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
4320 E. PRESIDIO STREET #101, MESA, AZ 85215-3031
(480) 706-9430
(480) 378-2273
Mailing address
5155 E. EAGLE DRIVE #20730, MESA, AZ 85277-3031
(480) 706-9430
(480) 378-2273
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5941
AZ
363AS0400X
Surgical Physician Assistant
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
983703
—
AZ
Enumeration date
11/13/2014
Last updated
04/19/2018
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