Provider Demographics
NPI:1861452583
Name:TAYLOR, ROGER Z (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:Z
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROGER
Other - Middle Name:Z
Other - Last Name:POZNIAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4090 MAPLESHADE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-0025
Mailing Address - Country:US
Mailing Address - Phone:972-986-5524
Mailing Address - Fax:
Practice Address - Street 1:4090 MAPLESHADE LN STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-0025
Practice Address - Country:US
Practice Address - Phone:972-986-5524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9042174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P01330137OtherRAILROAD MEDICARE
TX127619802Medicaid
TX109362701Medicaid
C22505Medicare UPIN
614060Medicare PIN