Provider Demographics
NPI:1073520250
Name:TAYLOR, SUSAN JANE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:TAYLOR
Suffix:
Gender:F
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:PO BOX 1315
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78841-1315
Mailing Address - Country:US
Mailing Address - Phone:830-775-5800
Mailing Address - Fax:
Practice Address - Street 1:1301 AVENUE G
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3627
Practice Address - Country:US
Practice Address - Phone:830-775-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6969207R00000X, 207RH0000X
TXE6968207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1225260 (07)Medicaid
TX8P5870OtherBCBS INDIVIDUAL NUMBER
TXP00175170OtherRR MEDICARE INDIVIDUAL #
TX8B8041Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #