Provider Demographics
NPI:1265456586
Name:TAYLOR, CLARENCE L (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:L
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 DISTEL CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1408
Mailing Address - Country:US
Mailing Address - Phone:415-878-7200
Mailing Address - Fax:415-369-1387
Practice Address - Street 1:101 ROWLAND WAY STE 220
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5056
Practice Address - Country:US
Practice Address - Phone:415-878-7200
Practice Address - Fax:415-369-1387
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA803448207R00000X
OH35052758207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC55454OtherSTATE MEDICAL LICENSE
OH0611387Medicaid
OHD79703Medicare UPIN