Provider Demographics
NPI:1003814674
Name:TAYLOR, MARVIN EUGENE (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:EUGENE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:655 7TH ST
Mailing Address - Street 2:78TH MDG/AMDS/SGPFO, BLDG 207
Mailing Address - City:ROBINS AFB
Mailing Address - State:GA
Mailing Address - Zip Code:31098-2227
Mailing Address - Country:US
Mailing Address - Phone:478-327-7578
Mailing Address - Fax:478-327-7678
Practice Address - Street 1:655 7TH ST
Practice Address - Street 2:78TH MDG/AMDS/SGPFO, BLDG 207
Practice Address - City:ROBINS AFB
Practice Address - State:GA
Practice Address - Zip Code:31098-2227
Practice Address - Country:US
Practice Address - Phone:478-327-7578
Practice Address - Fax:478-327-7678
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 616952083P0500X
IA232032083P0500X
MI43010451562083P0500X
MN424592083P0500X
MOR5D222083P0500X
OK159842083P0500X
WI25725-0202083P0500X
IL2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D42871Medicare UPIN