Provider Demographics
NPI:1528026697
Name:TAYLOR, BURT FOWLER (MD)
Entity Type:Individual
Prefix:DR
First Name:BURT
Middle Name:FOWLER
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:PO BOX 86144
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36689-6144
Mailing Address - Country:US
Mailing Address - Phone:251-476-5050
Mailing Address - Fax:251-450-2770
Practice Address - Street 1:6144 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-3143
Practice Address - Country:US
Practice Address - Phone:251-476-5050
Practice Address - Fax:251-450-2770
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00005854207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051079357OtherBCBS
MS00118989Medicaid
AL000079357Medicaid
200028695OtherRAILROAD MEDICARE
MS00118989Medicaid
AL000079357Medicare ID - Type Unspecified