Individual
JOHN RAY TAITANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
851 GOVERNOR CARLOS CAMACHO ROAD, TAMUNING, GU 96913-3153
(671) 300-0840
(671) 647-0832
Mailing address
122 WONPAT STREET, SINAJANA, GU 96910-0000
(671) 472-6961
(671) 647-0832
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
M675
GU
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
611
—
GU
01
—
M675
GUAM BOARD OF MEDICAL EXAMINERS LICENSURE
GU
Enumeration date
01/26/2007
Last updated
03/07/2023
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