Provider Demographics
NPI:1093814584
Name:TAYLOR, IAN S (MD)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:S
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 1:10054 OLD TULLAHOMA RD
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-6122
Mailing Address - Country:US
Mailing Address - Phone:931-455-6688
Mailing Address - Fax:931-455-0892
Practice Address - Street 1:10054 OLD TULLAHOMA RD
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-6122
Practice Address - Country:US
Practice Address - Phone:931-455-6688
Practice Address - Fax:931-455-0892
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26695207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3097601Medicaid
TNG20438Medicare UPIN
TN3097601Medicaid