Organization
MODERN ELIXIR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JUSTIN K TAYLOR N.M.D (PHYSICIAN)
(520) 308-5280
Entity
Organization
Contact information
Practice address
6818 N ORACLE RD, SUITE 414, TUCSON, AZ 85704-4249
(520) 308-5280
Mailing address
6818 N ORACLE RD, SUITE 414, TUCSON, AZ 85704-4249
(520) 308-5280
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MT-18699
AZ
Other
Enumeration date
04/21/2014
Last updated
04/21/2014
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