Provider Demographics
NPI:1073831533
Name:TAYLOR, STEVEN ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:ALLEN
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 1:1512 N GREEN MOUNT RD STE 108
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-2083
Mailing Address - Country:US
Mailing Address - Phone:618-624-5510
Mailing Address - Fax:618-624-5529
Practice Address - Street 1:1512 N GREEN MOUNT RD STE 108
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-2083
Practice Address - Country:US
Practice Address - Phone:618-624-5510
Practice Address - Fax:618-624-5529
Is Sole Proprietor?:No
Enumeration Date:2010-05-08
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036144257207Q00000X
WV24850171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL125-057453OtherIL TEMP TRAINING LICENSE
WV24850OtherWV STATE LICENSE