Provider Demographics
NPI:1346226529
Name:TAYLOR, MOIRAE MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:MOIRAE
Middle Name:MICHELLE
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 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:4343 N JOSEY LN
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75010-4603
Practice Address - Country:US
Practice Address - Phone:972-394-2412
Practice Address - Fax:972-394-2328
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5714207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX14678803Medicaid
TX146788807Medicaid
TX8B1132OtherBCBS
TX146788801Medicaid
TX146788810OtherMEDICAID CSHCN
TX146788806Medicaid
TX146788809Medicaid
TX146788808OtherMEDICAID CSHCN
TX146788801Medicaid
TX8019N4Medicare PIN
TX146788808OtherMEDICAID CSHCN
TXTXB107140Medicare PIN
TX146788810OtherMEDICAID CSHCN
TX8B1132OtherBCBS