Provider Demographics
NPI:1083935415
Name:FLYNN A. TAYLOR, M.D.,P.C.
Entity Type:Organization
Organization Name:FLYNN A. TAYLOR, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:FLYNN
Authorized Official - Middle Name:A
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-463-9890
Mailing Address - Street 1:412 S PINE ST
Mailing Address - Street 2:
Mailing Address - City:DERIDDER
Mailing Address - State:LA
Mailing Address - Zip Code:70634-4840
Mailing Address - Country:US
Mailing Address - Phone:337-463-9890
Mailing Address - Fax:337-462-9521
Practice Address - Street 1:412 S PINE ST
Practice Address - Street 2:
Practice Address - City:DERIDDER
Practice Address - State:LA
Practice Address - Zip Code:70634-4840
Practice Address - Country:US
Practice Address - Phone:337-463-9890
Practice Address - Fax:337-462-9521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-21
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA014367305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAPENDINGOtherMEDICARE
LA1186384Medicaid