Provider Demographics
NPI:1225087380
Name:TAYLOR, JAMES JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOHN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1802 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7357
Mailing Address - Country:US
Mailing Address - Phone:540-776-2020
Mailing Address - Fax:540-776-2019
Practice Address - Street 1:1802 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7357
Practice Address - Country:US
Practice Address - Phone:540-776-2020
Practice Address - Fax:540-776-2019
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012018846208600000X, 2086S0129X
VA0102204860208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1225087380Medicaid
TX045728502Medicaid
KS200879910AMedicaid
TXA8P8920OtherBLUE CROSS
VA1225087380Medicaid
NV1225087380Medicaid
MO1225087380Medicaid
KS200879910AMedicaid
TXA8P8920OtherBLUE CROSS