Individual
DANIEL TAILLEUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
19021 US HIGHWAY 285, LA JARA, CO 81140
(719) 274-6000
(719) 274-6038
Mailing address
PO BOX 639, LA JARA, CO 81140-0639
(719) 274-6000
(719) 274-6038
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50386
CO
208D00000X
General Practice Physician
11161
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11161
STATE LIC NUMBER
MT
01
—
50386
STATE LICENSE
CO
Enumeration date
10/02/2006
Last updated
10/22/2011
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