Provider Demographics
NPI:1235136532
Name:TAYLOR, JASON R (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1035 N EMPORIA ST
Mailing Address - Street 2:STE #105
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2944
Mailing Address - Country:US
Mailing Address - Phone:316-263-7285
Mailing Address - Fax:316-266-4682
Practice Address - Street 1:1035 N EMPORIA ST
Practice Address - Street 2:STE #105
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-2944
Practice Address - Country:US
Practice Address - Phone:316-263-7285
Practice Address - Fax:316-266-4682
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2018-07-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0427594174400000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100321950AMedicaid
KS100321950AMedicaid
KSG77245Medicare UPIN