Provider Demographics
NPI:1780686196
Name:TAYLOR, MARSHA A (MD)
Entity Type:Individual
Prefix:
First Name:MARSHA
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4941 N TOWNE CENTRE DR
Mailing Address - Street 2:
Mailing Address - City:OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65721-8280
Mailing Address - Country:US
Mailing Address - Phone:417-551-4810
Mailing Address - Fax:417-551-4814
Practice Address - Street 1:4941 N TOWNE CENTRE DR
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-8280
Practice Address - Country:US
Practice Address - Phone:417-551-4810
Practice Address - Fax:417-551-4814
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2024-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO119653207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1780686196Medicaid
MO204660740Medicaid
MOP02003372OtherRAILROAD MEDICARE PROVIDER PTAN
MA3714002OtherMEDICARE PTAN
D17133Medicare UPIN
MO204660740Medicaid