Provider Demographics
NPI:1336110774
Name:TAYLOR, TAMARRO LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:TAMARRO
Middle Name:LYNN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4000 (111H)
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-979-2706
Mailing Address - Fax:423-979-3609
Practice Address - Street 1:BLDG 8 DOGWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-979-2706
Practice Address - Fax:423-979-3609
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN40122174400000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G72606Medicare UPIN
TN3336098Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL #