Provider Demographics
NPI:1306416607
Name:DILLARD, TAYLOR CALLI (DO)
Entity Type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:CALLI
Last Name:DILLARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:TAYLOR
Other - Middle Name:CALLI
Other - Last Name:ROGERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1400 BRYAN DR STE 201
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-2157
Mailing Address - Country:US
Mailing Address - Phone:580-924-5500
Mailing Address - Fax:
Practice Address - Street 1:1400 BRYAN DR STE 201
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2157
Practice Address - Country:US
Practice Address - Phone:580-924-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0428R207Q00000X
OK7687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty