Individual
BLAKE TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
475 W 940 N, PROVO, UT 84604-3301
(801) 357-7926
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
10939818-1204
UT
Other
Enumeration date
03/21/2017
Last updated
02/25/2019
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