Provider Demographics
NPI:1861834798
Name:TAYLOR, BRIAN JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOSEPH
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1272 EAST ST
Mailing Address - Street 2:
Mailing Address - City:WAYNESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28786-3437
Mailing Address - Country:US
Mailing Address - Phone:828-456-3511
Mailing Address - Fax:828-456-3583
Practice Address - Street 1:1272 EAST ST
Practice Address - Street 2:
Practice Address - City:WAYNESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28786-3437
Practice Address - Country:US
Practice Address - Phone:828-456-3511
Practice Address - Fax:828-456-3583
Is Sole Proprietor?:No
Enumeration Date:2013-07-19
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA 60404645363A00000X
NC001005014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCJ941D811Medicare PIN
WAG8925500Medicare PIN
WAG8925504Medicare PIN
WAG8925502Medicare PIN
WAG8925501Medicare PIN