Provider Demographics
NPI:1417005711
Name:TAYLOR, RALPH (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:RALPH
Other - Middle Name:
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1750 MADISON AVE
Mailing Address - Street 2:401
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6492
Mailing Address - Country:US
Mailing Address - Phone:901-276-2357
Mailing Address - Fax:
Practice Address - Street 1:1750 MADISON AVE
Practice Address - Street 2:401
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6492
Practice Address - Country:US
Practice Address - Phone:901-276-2357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14448207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN110220118OtherRAILROAD MEDICARE
TN3158473OtherBCBSTN
TN4031705OtherAETNA
TN4031705OtherAETNA
TNB04774Medicare UPIN
TN3198019Medicare ID - Type Unspecified