Provider Demographics
NPI:1922050889
Name:TAYLOR, MARY A (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 YOUREE DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71115-2302
Mailing Address - Country:US
Mailing Address - Phone:318-212-2870
Mailing Address - Fax:318-212-2875
Practice Address - Street 1:8001 YOUREE DR
Practice Address - Street 2:SUITE 320
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71115-2302
Practice Address - Country:US
Practice Address - Phone:318-212-2870
Practice Address - Fax:318-212-2875
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA021137207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00256934OtherMEDICARE RR
LA1973017Medicaid
LA5U581CV71Medicare PIN
LA5U581Medicare PIN
F87341Medicare UPIN
LA1973017Medicaid