Provider Demographics
NPI:1134325988
Name:TAYLOR, SAMUEL CLAYTON (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:CLAYTON
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 1:4512 TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-3455
Mailing Address - Country:US
Mailing Address - Phone:405-974-0728
Mailing Address - Fax:800-305-3233
Practice Address - Street 1:1801 HICKMAN RD
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-1548
Practice Address - Country:US
Practice Address - Phone:515-282-5773
Practice Address - Fax:515-282-2332
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA38547207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine