Provider Demographics
NPI:1093918039
Name:TAYLOR, MARCIA LISA (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:LISA
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6124 W PARKER RD
Mailing Address - Street 2:SUITE 134
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8122
Mailing Address - Country:US
Mailing Address - Phone:972-981-7777
Mailing Address - Fax:
Practice Address - Street 1:6124 W PARKER RD
Practice Address - Street 2:SUITE 134
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8122
Practice Address - Country:US
Practice Address - Phone:972-981-7777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
BP1-0022882OtherINSTITUTIONAL PERMIT