Provider Demographics
NPI:1093974099
Name:GWIN, TAYLOR SCOTT (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:SCOTT
Last Name:GWIN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8585 PICARDY AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3679
Mailing Address - Country:US
Mailing Address - Phone:225-767-5479
Mailing Address - Fax:225-767-5147
Practice Address - Street 1:8585 PICARDY AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-3679
Practice Address - Country:US
Practice Address - Phone:225-767-5479
Practice Address - Fax:225-767-5147
Is Sole Proprietor?:No
Enumeration Date:2008-06-04
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD2040292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1092231Medicaid
LA417361ZPPRMedicare UPIN