Provider Demographics
NPI:1528010139
Name:TAYLOR, LARRY R (CRNA)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 173608
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-3608
Mailing Address - Country:US
Mailing Address - Phone:325-675-6466
Mailing Address - Fax:817-412-7020
Practice Address - Street 1:2407 WIMBLEDON DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017
Practice Address - Country:US
Practice Address - Phone:817-465-3614
Practice Address - Fax:817-472-0694
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX227469367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00SD39OtherBCBS
TX109792506Medicaid
TX00173CMedicare ID - Type Unspecified
TX109792506Medicaid