Provider Demographics
NPI:1154478790
Name:JOHN N TAYLOR, MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JOHN N TAYLOR, MD A PROFESSIONAL CORPORATION
Other - Org Name:JOHN N TAYLOR, MD A PROFESSIONAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-341-6262
Mailing Address - Street 1:41990 COOK ST BLDG J
Mailing Address - Street 2:SUITE 901
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92211-6100
Mailing Address - Country:US
Mailing Address - Phone:760-341-6262
Mailing Address - Fax:760-341-6226
Practice Address - Street 1:41990 COOK ST BLDG J
Practice Address - Street 2:SUITE 901
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-6100
Practice Address - Country:US
Practice Address - Phone:760-341-6262
Practice Address - Fax:760-341-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90426OtherSTATE LICENSE
CAZZZ04511ZMedicare PIN