Provider Demographics
NPI:1922765981
Name:TAYLOR, JOSH AUSTIN
Entity Type:Individual
Prefix:
First Name:JOSH
Middle Name:AUSTIN
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12345 ROSE HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46235-6059
Mailing Address - Country:US
Mailing Address - Phone:317-640-4013
Mailing Address - Fax:
Practice Address - Street 1:6038 N KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2590
Practice Address - Country:US
Practice Address - Phone:317-296-4914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor