Provider Demographics
NPI:1912012832
Name:TAYLOR, JILL ANN (DO)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANN
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1806 HUMBLE PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-5277
Mailing Address - Country:US
Mailing Address - Phone:281-359-4220
Mailing Address - Fax:281-359-4208
Practice Address - Street 1:1806 HUMBLE PLACE DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-5277
Practice Address - Country:US
Practice Address - Phone:281-359-4220
Practice Address - Fax:281-359-4208
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX710959498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00462JOtherMEDICARE PTAN
TX2044695OtherAETNA
TX0049DFOtherBLUE CROSS BLUE SHIELD
TX8M1980OtherBLUE CROSS BLUE SHIELD
TX3342691OtherBLUE CROSS BLUE SHIELD HM
TX8M1980OtherBLUE CROSS BLUE SHIELD