Provider Demographics
NPI:1821135690
Name:TAYLOR, RICHARD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
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 1:214 CARTER ST
Mailing Address - Street 2:
Mailing Address - City:BERRYVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72616-4303
Mailing Address - Country:US
Mailing Address - Phone:870-423-3355
Mailing Address - Fax:870-423-5268
Practice Address - Street 1:214 CARTER ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:AR
Practice Address - Zip Code:72616-4303
Practice Address - Country:US
Practice Address - Phone:870-423-3355
Practice Address - Fax:870-423-5268
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARC6251207Q00000X
MOR2G30207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO55233OtherAR BLUE SHIELD #
MO149386OtherHEALTHLINK PROV. #
MO202405205Medicaid
AR110881001Medicaid
AR55233OtherAR BLUE SHIELD #
MOB18616Medicare UPIN
AR110881001Medicaid
MO202405205Medicaid
MO55233OtherAR BLUE SHIELD #