Provider Demographics
NPI:1609175934
Name:TAYLOR, MICHELLE MCCOY (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MCCOY
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:CLAIRE
Other - Last Name:MCCOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4212 W CONGRESS ST STE 2300A
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6778
Mailing Address - Country:US
Mailing Address - Phone:337-456-1642
Mailing Address - Fax:337-456-4913
Practice Address - Street 1:4212 W CONGRESS ST STE 2300A
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6778
Practice Address - Country:US
Practice Address - Phone:337-456-1642
Practice Address - Fax:337-456-4913
Is Sole Proprietor?:No
Enumeration Date:2011-03-25
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.206353207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2150961Medicaid