Provider Demographics
NPI:1275120313
Name:TAYLOR, TERRY EUGENE III (PA-C)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:EUGENE
Last Name:TAYLOR
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:36125 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-5721
Mailing Address - Country:US
Mailing Address - Phone:909-907-2441
Mailing Address - Fax:
Practice Address - Street 1:33494 OAK GLEN RD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2057
Practice Address - Country:US
Practice Address - Phone:909-797-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant