Provider Demographics
NPI:1245214717
Name:TAYLOR, JEFFREY PATRICK (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PATRICK
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 WESTPARK WAY
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3957
Mailing Address - Country:US
Mailing Address - Phone:817-283-5151
Mailing Address - Fax:817-283-8360
Practice Address - Street 1:401 WESTPARK WAY
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3957
Practice Address - Country:US
Practice Address - Phone:817-283-5151
Practice Address - Fax:817-283-8360
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1421213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018579501Medicaid
TX751704354OtherTAX ID
TX00314KMedicare ID - Type UnspecifiedGROUP
TX8854N0Medicare ID - Type Unspecified
TX751704354OtherTAX ID
TX0156300002Medicare NSC