Provider Demographics
NPI:1558622779
Name:TAYLOR, ERIC W (RPA, RT(R))
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:RPA, RT(R)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SUNSET DR
Mailing Address - Street 2:SUITE #3
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-7906
Mailing Address - Country:US
Mailing Address - Phone:423-431-6789
Mailing Address - Fax:423-431-5291
Practice Address - Street 1:1301 SUNSET DR
Practice Address - Street 2:SUITE #3
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-7906
Practice Address - Country:US
Practice Address - Phone:423-431-6789
Practice Address - Fax:423-431-5291
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-05
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRA0000000005.243U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes243U00000XTechnologists, Technicians & Other Technical Service ProvidersRadiology Practitioner Assistant