Provider Demographics
NPI:1326386897
Name:JAMES D TAYLOR MD INC
Entity Type:Organization
Organization Name:JAMES D TAYLOR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-455-0914
Mailing Address - Street 1:155 ANDERSEN DR STE 1108
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3999
Mailing Address - Country:US
Mailing Address - Phone:415-455-0914
Mailing Address - Fax:415-454-4315
Practice Address - Street 1:155 ANDERSEN DR STE 1108
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3999
Practice Address - Country:US
Practice Address - Phone:415-455-0914
Practice Address - Fax:415-454-4315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG62102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE82-794Medicare UPIN