Individual
DR. WALLACE EDMONDSON TAYLOR JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
300 BEARDSLEY LN, SUITE D-101, AUSTIN, TX 78746-4945
(512) 338-9840
(512) 338-0863
Mailing address
300 BEARDSLEY LN, SUITE D-101, AUSTIN, TX 78746-4945
(512) 338-9840
(512) 338-0863
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
28006
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01280064
—
CO
01
—
P00209209
MEDICARE RAILROAD CARRIER
CO
01
—
TA37805
ANTHEM BC/BS
CO
Enumeration date
12/02/2005
Last updated
12/04/2008
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