Provider Demographics
NPI:1972502664
Name:TAYLOR, TRINA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:TRINA
Middle Name:LOUISE
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 1:212 NORTH BONHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TX
Mailing Address - Zip Code:77327-4512
Mailing Address - Country:US
Mailing Address - Phone:281-432-7400
Mailing Address - Fax:281-432-7400
Practice Address - Street 1:212 NORTH BONHAM AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4512
Practice Address - Country:US
Practice Address - Phone:281-432-7400
Practice Address - Fax:281-432-7400
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8213208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX163465102Medicaid
TX163465102Medicaid
I07196Medicare UPIN