Provider Demographics
NPI:1417981788
Name:TAYLOR, JOHN BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRUCE
Last Name:TAYLOR
Suffix:
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 1:2310 RANDOLPH RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1526
Mailing Address - Country:US
Mailing Address - Phone:704-650-7156
Mailing Address - Fax:855-695-6439
Practice Address - Street 1:2310 RANDOLPH RD UNIT B
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1526
Practice Address - Country:US
Practice Address - Phone:704-650-7156
Practice Address - Fax:855-695-6439
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24103207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC82098OtherBCBS
NC8982098Medicaid
SCN24103Medicaid
NC160037096Medicare PIN
NCC86280Medicare UPIN
NC1417981788Medicaid