Provider Demographics
NPI:1245381409
Name:TAYLOR, TERRY W (MD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2203 PERIMETER RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36615-1130
Mailing Address - Country:US
Mailing Address - Phone:251-434-6770
Mailing Address - Fax:251-434-6759
Practice Address - Street 1:2203 PERIMETER RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36615-1130
Practice Address - Country:US
Practice Address - Phone:251-434-6770
Practice Address - Fax:251-434-6759
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD147132083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-61542OtherBLUE CROSS PROV ID-WEST
ALD17135Medicare UPIN