Provider Demographics
NPI:1932104601
Name:TAYLOR, DAVID RAY JR (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RAY
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:5640 N FRESNO ST
Mailing Address - Street 2:STE 110
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-6098
Mailing Address - Country:US
Mailing Address - Phone:559-266-9906
Mailing Address - Fax:559-266-0906
Practice Address - Street 1:5640 N FRESNO ST
Practice Address - Street 2:STE 110
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6098
Practice Address - Country:US
Practice Address - Phone:559-266-9906
Practice Address - Fax:559-266-0906
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAA313100207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26432Medicare UPIN
CAZZZ96659ZMedicare ID - Type Unspecified