Provider Demographics
NPI:1891891156
Name:TAYLOR, JOHN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:THOMAS
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 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-4004
Mailing Address - Fax:219-326-2584
Practice Address - Street 1:1331 STATE ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3112
Practice Address - Country:US
Practice Address - Phone:219-326-5700
Practice Address - Fax:219-326-8131
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027579A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100215330Medicaid
IN000001623828OtherANTHEM
IN000001589732OtherANTHEM
IN000000587935OtherANTHEM, BCBS
IN000001589986OtherANTHEM