Provider Demographics
NPI:1689676140
Name:G.B. TAYLOR, D.O., P.A.
Entity Type:Organization
Organization Name:G.B. TAYLOR, D.O., P.A.
Other - Org Name:G.B. TAYLOR, D.O., P.A.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:903-572-1951
Mailing Address - Street 1:2320 HARTS BLUFF RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MT PLEASANT
Mailing Address - State:TX
Mailing Address - Zip Code:75455-7453
Mailing Address - Country:US
Mailing Address - Phone:903-572-1951
Mailing Address - Fax:903-572-2590
Practice Address - Street 1:2320 HARTS BLUFF RD
Practice Address - Street 2:SUITE A
Practice Address - City:MT PLEASANT
Practice Address - State:TX
Practice Address - Zip Code:75455-7453
Practice Address - Country:US
Practice Address - Phone:903-572-1951
Practice Address - Fax:903-572-2590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1716581Medicaid
TXDD1496OtherMEDICARE RAILROAD
TX00335YMedicare ID - Type Unspecified