Provider Demographics
NPI:1346209798
Name:TAYLOR, VERNON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:
Last Name:TAYLOR
Suffix:JR
Gender:M
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 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-3405
Mailing Address - Fax:812-450-3099
Practice Address - Street 1:600 MARY STREET
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47747-0001
Practice Address - Country:US
Practice Address - Phone:812-450-3405
Practice Address - Fax:812-450-3099
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037686A207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100337540BMedicaid
IN352125229OtherTAX ID
IN100337540Medicaid
IN100337540Medicaid
IN534980AMedicare PIN
IN534980AMedicare ID - Type UnspecifiedDEACONESS ER LOCATION