| Organization Name: | GERALD J TAITAGUE MD PC |
| NPI Number: | 1689813834 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GERALD J TAITAGUE (PRESIDENT/PHYSICIAN) |
| Mailing Address: | 117 W Route 66 Suite 190 Williams |
| State: | AZ US |
| Postal Code: | 860462567 |
| Phone Number: | 9286351044 |
| Fax Number: | 9286351042 |
| NPI Enumeration Date: | 02/11/2009 |
| NPI Last Update Date: | 02/11/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | 26182 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |