Provider Demographics
NPI:1689641300
Name:TAYLOR, JAY M (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:M
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 1:9500 MENTOR AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-8713
Mailing Address - Country:US
Mailing Address - Phone:440-352-4880
Mailing Address - Fax:440-352-3629
Practice Address - Street 1:9500 MENTOR AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8713
Practice Address - Country:US
Practice Address - Phone:440-352-4880
Practice Address - Fax:440-352-3629
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049371207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0586601Medicaid
OHA15632Medicare UPIN
TA 0544172Medicare PIN
OH0586601Medicaid
TA 0544172Medicare PIN