Individual
ETHAN TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 606-4522
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
853309
TX
163W00000X
Registered Nurse
RN139391
LA
367500000X
Certified Registered Nurse Anesthetist
Primary
AP132890
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
367663705
—
TX
01
—
8LX980
BCBS
TX
Enumeration date
12/27/2016
Last updated
04/30/2021
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