Provider Demographics
NPI:1609925593
Name:TAYLOR, JAMES WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WALTER
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 1:1930 ALCOA HWY
Mailing Address - Street 2:SUITE 235 BLDG A
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1500
Mailing Address - Country:US
Mailing Address - Phone:865-305-6545
Mailing Address - Fax:865-305-6547
Practice Address - Street 1:1930 ALCOA HWY
Practice Address - Street 2:SUITE 235 BLDG A
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1500
Practice Address - Country:US
Practice Address - Phone:865-305-6545
Practice Address - Fax:865-305-6547
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10519208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN2003915OtherBLUECROSS BLUESHIELD
TN3163922Medicare PIN
TN2003915OtherBLUECROSS BLUESHIELD