Provider Demographics
NPI:1568491017
Name:TAYLOR, SAMUEL WAYNE JR (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:WAYNE
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2101 HIGHLAND AVE S
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4022
Mailing Address - Country:US
Mailing Address - Phone:205-933-2625
Mailing Address - Fax:205-558-2553
Practice Address - Street 1:500 HARGROVE RD E
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-3751
Practice Address - Country:US
Practice Address - Phone:205-933-2625
Practice Address - Fax:205-558-2553
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15903207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940914Medicaid
AL009940914Medicaid