Provider Demographics
NPI:1578859039
Name:VICE, TAYLOR FREDERICK RANDALL (MD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:FREDERICK RANDALL
Last Name:VICE
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 1:652 STONE CROSS DR
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-9082
Mailing Address - Country:US
Mailing Address - Phone:260-316-8695
Mailing Address - Fax:
Practice Address - Street 1:652 STONE CROSS DR
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-9082
Practice Address - Country:US
Practice Address - Phone:260-316-8695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2016-01237207L00000X
IN01077405A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology