Provider Demographics
NPI:1821198052
Name:TAYLOR, ROBERT W JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:TAYLOR
Suffix:JR
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 1:2551 GREENWOOD ROAD
Mailing Address - Street 2:STE 210
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-3905
Mailing Address - Country:US
Mailing Address - Phone:318-635-0834
Mailing Address - Fax:318-636-2331
Practice Address - Street 1:2551 GREENWOOD ROAD
Practice Address - Street 2:STE 210
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-3905
Practice Address - Country:US
Practice Address - Phone:318-635-0834
Practice Address - Fax:318-636-2331
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA013333207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1341231Medicaid
LA1341231Medicaid
LA5L734C043Medicare ID - Type Unspecified