Provider Demographics
NPI:1659449288
Name:TAYLOR, ROOSEVELT JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROOSEVELT
Middle Name:
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:9209 ELAM RD STE 100
Mailing Address - Street 2:ROOSEVELT TAYLOR JR MD
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-7360
Mailing Address - Country:US
Mailing Address - Phone:214-391-3700
Mailing Address - Fax:214-391-7195
Practice Address - Street 1:9209 ELAM RD STE 100
Practice Address - Street 2:ROOSEVELT TAYLOR JR MD
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-7360
Practice Address - Country:US
Practice Address - Phone:214-391-3700
Practice Address - Fax:214-391-7195
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXD9896207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX121397702Medicaid
00M973OtherBLUE CROSS BLUE SHIELD
TX00M973Medicare ID - Type Unspecified
00M973OtherBLUE CROSS BLUE SHIELD