Provider Demographics
NPI:1598774945
Name:TAYLOR, STEPHANIE R (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:R
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 HOSPITAL PKWY STE 109
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-5935
Mailing Address - Country:US
Mailing Address - Phone:817-684-5002
Mailing Address - Fax:817-684-5150
Practice Address - Street 1:1615 HOSPITAL PKWY STE 109
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-5935
Practice Address - Country:US
Practice Address - Phone:817-684-5002
Practice Address - Fax:817-684-5150
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4583207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BW431OtherBCBS
TX185578502Medicaid
TX185578502Medicaid
TX8L7790Medicare PIN