Provider Demographics
NPI:1275037905
Name:CLEMENTS, TAYLOR WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:WILLIAM
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 122205 DEPT 2205
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-4658
Mailing Address - Country:US
Mailing Address - Phone:337-494-2772
Mailing Address - Fax:337-494-2928
Practice Address - Street 1:4345 NELSON RD STE 201
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4183
Practice Address - Country:US
Practice Address - Phone:337-494-6800
Practice Address - Fax:337-494-6811
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2022-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA328261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2568434Medicaid
LA328261OtherSTATE LICENSE