Provider Demographics
NPI:1477741627
Name:DAVID R TAYLOR MD INC
Entity Type:Organization
Organization Name:DAVID R TAYLOR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:559-266-9906
Mailing Address - Street 1:5640 N FRESNO ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6098
Mailing Address - Country:US
Mailing Address - Phone:559-266-9906
Mailing Address - Fax:559-266-0906
Practice Address - Street 1:5640 N FRESNO ST
Practice Address - Street 2:SUITE 110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6098
Practice Address - Country:US
Practice Address - Phone:559-266-9906
Practice Address - Fax:559-266-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA313100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ96659ZOtherMEDICARE