Provider Demographics
NPI:1609871532
Name:TAYLOR, JOHN RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RICHARD
Last Name:TAYLOR
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 1:22455 MAPLE CT
Mailing Address - Street 2:STE 305
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-4031
Mailing Address - Country:US
Mailing Address - Phone:510-889-6155
Mailing Address - Fax:510-889-8498
Practice Address - Street 1:22455 MAPLE CT
Practice Address - Street 2:STE 305
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-4031
Practice Address - Country:US
Practice Address - Phone:510-889-6155
Practice Address - Fax:510-889-8498
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34840207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A35746Medicare UPIN