Provider Demographics
NPI:1942292586
Name:TAYLOR, PEGGY H (MD)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:H
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 1:450 MEDICAL CENTER BLVD
Mailing Address - Street 2:400
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4234
Mailing Address - Country:US
Mailing Address - Phone:281-338-0085
Mailing Address - Fax:281-332-9532
Practice Address - Street 1:450 MEDICAL CENTER BLVD
Practice Address - Street 2:400
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4234
Practice Address - Country:US
Practice Address - Phone:281-338-0085
Practice Address - Fax:281-332-9532
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXF74286Medicare UPIN
TX8344B7Medicare ID - Type Unspecified