Provider Demographics
NPI:1316178346
Name:M.R. TAYLOR RAYBURN, JR. M.D. P.C.
Entity Type:Organization
Organization Name:M.R. TAYLOR RAYBURN, JR. M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAYLOR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYBURN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:931-381-1425
Mailing Address - Street 1:1411 HATCHER LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-3535
Mailing Address - Country:US
Mailing Address - Phone:931-381-1425
Mailing Address - Fax:
Practice Address - Street 1:1411 HATCHER LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-3535
Practice Address - Country:US
Practice Address - Phone:931-381-1425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-08
Last Update Date:2009-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD3322207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNMD3322OtherSTATE MEDICAL LICENSE NUMBER