Provider Demographics
NPI:1821074162
Name:TAYLOR, RUSSELL J (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:J
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:PO BOX 636930
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0001
Mailing Address - Country:US
Mailing Address - Phone:513-981-5123
Mailing Address - Fax:513-981-5015
Practice Address - Street 1:770 WEST HIGH STREET
Practice Address - Street 2:SUITE 350
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45801-5901
Practice Address - Country:US
Practice Address - Phone:419-228-8950
Practice Address - Fax:419-224-7904
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2013-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35045028208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH06151OtherPARAMOUNT ADVANTAGE MEDICAID
OH0437932Medicaid
OH4218612OtherAETNA
OH735041OtherBUCKEYE MEDICAID
OH3358254OtherCIGNA
OH000000596289OtherANTHEM PIN
OH262788491032OtherCARESOURCE MEDICAID
OH735041OtherBUCKEYE MEDICAID
OHTA0508729Medicare PIN