Provider Demographics
NPI:1851651483
Name:TAYLOR, ZACHARY ELY (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ELY
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 1:13409 GEORGE RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3064
Mailing Address - Country:US
Mailing Address - Phone:210-492-8922
Mailing Address - Fax:210-479-2010
Practice Address - Street 1:1 VALERO WAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-1616
Practice Address - Country:US
Practice Address - Phone:210-492-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-16
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ0189207Q00000X
MN61644207Q00000X
TXBP10044793390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX364706YMJUMedicare PIN