Provider Demographics
NPI:1376586545
Name:TAYLOR, THANH (DO)
Entity Type:Individual
Prefix:
First Name:THANH
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21022 BARKER CANYON LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-6900
Mailing Address - Country:US
Mailing Address - Phone:888-704-9203
Mailing Address - Fax:888-369-0336
Practice Address - Street 1:5423 E 5TH ST STE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2522
Practice Address - Country:US
Practice Address - Phone:888-704-9203
Practice Address - Fax:888-369-0336
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2015-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9907207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX147007201Medicaid
TX00784QMedicaid
TX147007201Medicaid