Provider Demographics
NPI:1083021554
Name:TAYLOR, AUSTIN BLAKE (DO)
Entity Type:Individual
Prefix:DR
First Name:AUSTIN
Middle Name:BLAKE
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:340 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-2624
Mailing Address - Country:US
Mailing Address - Phone:276-628-3118
Mailing Address - Fax:276-628-8342
Practice Address - Street 1:340 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-2624
Practice Address - Country:US
Practice Address - Phone:276-628-3118
Practice Address - Fax:276-628-8342
Is Sole Proprietor?:No
Enumeration Date:2014-07-16
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04355207W00000X
VA0102205806207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0102205806OtherVIRGINIA DEPARTMENT OF HEALTH