Provider Demographics
NPI:1558433458
Name:TAYLOR, ROBERT PAUL (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PAUL
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5575 WARREN PKWY
Mailing Address - Street 2:STE. 101
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:972-712-4161
Mailing Address - Fax:972-712-4289
Practice Address - Street 1:5575 WARREN PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4066
Practice Address - Country:US
Practice Address - Phone:972-712-4161
Practice Address - Fax:972-712-4289
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1354213E00000X
GA000764213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00746EMedicare ID - Type Unspecified
TXU64887Medicare UPIN