Individual
DR. LAURENCE EDWARD TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
94180 2ND ST, GOLD BEACH, OR 97444-8733
(541) 247-7047
(541) 247-0123
Mailing address
1900 WOODLAND DR, COOS BAY, OR 97420-0000
(541) 267-5151
(541) 266-4501
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
DO12821
OR
207Q00000X
Family Medicine Physician
Primary
DO12821
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080167069
RR MEDICARE PTAN NUMBER
OR
01
—
1407812365
NBMC GROUP NPI NUMBER
OR
05
—
227421
—
OR
01
—
CB3544
RR MEDICARE GROUP NUMBER
OR
01
—
R0000WFBTV
MEDICARE GROUP PIN NUMBER
OR
Enumeration date
12/16/2005
Last updated
04/25/2011
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