Provider Demographics
NPI:1841246121
Name:TAYLOR, TAD W (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TAD
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 N COLLINS BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3525
Mailing Address - Country:US
Mailing Address - Phone:214-575-8700
Mailing Address - Fax:214-575-8705
Practice Address - Street 1:1920 N COLLINS BLVD
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3525
Practice Address - Country:US
Practice Address - Phone:214-575-8700
Practice Address - Fax:214-575-8705
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3863174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8U9680OtherBCBS PROVIDER NUMBER
TX104843103Medicaid
TX104843103Medicaid
TX203612015OtherEIN NUMBER
TX203612015OtherEIN NUMBER
TXBT5171741OtherDEA