NPIMap

Organization Active NPI

Modern Elixir

  • Specialist
  • Tucson, AZ
National Provider Identifier
1710307590
Registry record updated Apr 21, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
MT-18699 Issued in AZ
Legal business name
MODERN ELIXIR
Practice address
6818 N Oracle Rd
Suite 414
Tucson, AZ 85704-4249
Phone
(520) 308-5280
NPI assigned
Apr 21, 2014
Last updated
Apr 21, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Justin K Taylor, N.M.D
Title
Physician
Phone
(520) 308-5280

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X MT-18699 AZ Primary

Addresses

Primary practice location

6818 N Oracle Rd
Suite 414
Tucson, AZ 85704-4249

Mailing address

6818 N Oracle Rd
Suite 414
Tucson, AZ 85704-4249
Phone (520) 308-5280

National Provider Directory

National Provider Directory
Tax ID family
Modern Elixir2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1398038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398038400000",
    "number": "1710307590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6818 N ORACLE RD",
            "address_2": "SUITE 414",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857044249",
            "telephone_number": "520-308-5280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6818 N ORACLE RD",
            "address_2": "SUITE 414",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857044249",
            "telephone_number": "520-308-5280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN ELIXIR",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-21",
        "last_updated": "2014-04-21",
        "status": "A",
        "authorized_official_last_name": "TAYLOR",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "520-308-5280",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "N.M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "AZ",
            "license": "MT-18699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.