Provider Demographics
NPI:1467966143
Name:TAYLOR, RAY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RAY
Middle Name:RICHARD
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 1:1618 POLO CLUB CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40245-4482
Mailing Address - Country:US
Mailing Address - Phone:502-254-3273
Mailing Address - Fax:
Practice Address - Street 1:1618 POLO CLUB CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-4482
Practice Address - Country:US
Practice Address - Phone:502-254-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-17
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27510207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine