Provider Demographics
NPI:1558334557
Name:TAYLOR, BERNARD G (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:G
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 1:132 E MOSSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-9793
Mailing Address - Country:US
Mailing Address - Phone:309-645-8588
Mailing Address - Fax:309-579-3011
Practice Address - Street 1:132 E MOSSVILLE RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-9793
Practice Address - Country:US
Practice Address - Phone:309-645-8588
Practice Address - Fax:309-579-3011
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-053087207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036053087Medicaid
IL7215156OtherBCBSIL
ILIL2005002OtherMCR ID NUMBER
IL7215156OtherBCBSIL
ILD09838Medicare UPIN