Provider Demographics
NPI:1629267141
Name:AYLOR, ARDEN LEROY (MD)
Entity Type:Individual
Prefix:
First Name:ARDEN
Middle Name:LEROY
Last Name:AYLOR
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 1:803 NORTH ST E
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-2529
Mailing Address - Country:US
Mailing Address - Phone:256-362-1600
Mailing Address - Fax:256-362-8698
Practice Address - Street 1:803 NORTH ST E
Practice Address - Street 2:
Practice Address - City:TALLADEGA
Practice Address - State:AL
Practice Address - Zip Code:35160-2529
Practice Address - Country:US
Practice Address - Phone:256-362-1600
Practice Address - Fax:256-362-8698
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42258207QG0300X
AL28874207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL511-35487OtherBLUE CROSS BLUE SHIELD
TX1996126-01Medicaid
TXPP30842OtherBLUE CROSS BLUE SHIELD
AL511-35487OtherBLUE CROSS BLUE SHIELD
TXPP30842OtherBLUE CROSS BLUE SHIELD