Provider Demographics
NPI:1174551337
Name:TAYLOR, RICHARD HARLAN (MD)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HARLAN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CLAREMONT
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-752-8282
Mailing Address - Fax:406-257-2225
Practice Address - Street 1:75 CLAREMONT
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-8282
Practice Address - Fax:406-257-2225
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2018-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8752207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0068748Medicaid
MTD07572Medicare UPIN
MT0068748Medicaid