Provider Demographics
NPI:1831143619
Name:TAYLOR, ROBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
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 1:4210 N ROXBORO ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-1874
Mailing Address - Country:US
Mailing Address - Phone:919-620-7800
Mailing Address - Fax:919-620-7807
Practice Address - Street 1:4210 N ROXBORO ST
Practice Address - Street 2:SUITE 140
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-1874
Practice Address - Country:US
Practice Address - Phone:919-620-7800
Practice Address - Fax:919-620-7807
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 34749207Y00000X
NCNC34749207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890219VMedicaid
NC82148OtherBLUE CROSS INDIVIDUAL
F08816Medicare UPIN
NC890219VMedicaid