Provider Demographics
NPI:1598948812
Name:TAYLOR, JERRY W JR (NMD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:W
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 DANA RD.
Mailing Address - Street 2:
Mailing Address - City:BIG SANDY
Mailing Address - State:MT
Mailing Address - Zip Code:59520-8225
Mailing Address - Country:US
Mailing Address - Phone:406-378-2607
Mailing Address - Fax:
Practice Address - Street 1:969 DANA RD.
Practice Address - Street 2:
Practice Address - City:BIG SANDY
Practice Address - State:MT
Practice Address - Zip Code:59520-8225
Practice Address - Country:US
Practice Address - Phone:406-378-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT111175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath