Provider Demographics
NPI:1083617856
Name:TAYLOR, JAMES H (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
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 1:600 W PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3260
Mailing Address - Country:US
Mailing Address - Phone:386-738-0322
Mailing Address - Fax:386-738-0628
Practice Address - Street 1:600 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3260
Practice Address - Country:US
Practice Address - Phone:386-738-0322
Practice Address - Fax:386-738-0628
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME35651207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL054315200Medicaid
FL054315200Medicaid
FL070000065Medicare PIN
FL95668Medicare ID - Type Unspecified