Provider Demographics
NPI:1851351548
Name:TAYLOR, JAMES ALLAN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ALLAN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:1331 HORTON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-5260
Mailing Address - Country:US
Mailing Address - Phone:517-784-4242
Mailing Address - Fax:517-784-6943
Practice Address - Street 1:4219 MAYBECK DR. NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525
Practice Address - Country:US
Practice Address - Phone:616-724-4877
Practice Address - Fax:616-724-4641
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-25
Last Update Date:2021-03-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01-20052OtherPHYSICIANS HEALTH PLAN
383314200OtherFEDERAL TAX ID NUMBER
E50136Medicare UPIN
P55430001Medicare PIN