Provider Demographics
NPI:1417342338
Name:TAYLOR, ERICA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
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 1:8235 SHERRI OAKS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-3217
Mailing Address - Country:US
Mailing Address - Phone:210-414-0621
Mailing Address - Fax:
Practice Address - Street 1:8235 SHERRI OAKS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-3217
Practice Address - Country:US
Practice Address - Phone:210-414-0621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS03852084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX404648401Medicaid
TX8LW430OtherBCBS
TX404648402OtherMEDICAID-CSHCN