Provider Demographics
NPI:1548559792
Name:TAYLOR, PAUL CLAYTON
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:CLAYTON
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:LA
Mailing Address - Zip Code:71220-3003
Mailing Address - Country:US
Mailing Address - Phone:318-283-5102
Mailing Address - Fax:318-281-3975
Practice Address - Street 1:727 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:LA
Practice Address - Zip Code:71220-3003
Practice Address - Country:US
Practice Address - Phone:318-283-5102
Practice Address - Fax:318-281-3975
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-28
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA11361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist