Provider Demographics
NPI:1023115730
Name:TAYLOR, DAWN C (MD)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:C
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 1:445 LINCOLN DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:40069-1578
Mailing Address - Country:US
Mailing Address - Phone:270-692-9559
Mailing Address - Fax:270-692-9236
Practice Address - Street 1:445 LINCOLN DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:KY
Practice Address - Zip Code:40069-1578
Practice Address - Country:US
Practice Address - Phone:270-692-9559
Practice Address - Fax:270-692-9236
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31359207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000044307OtherBCBS PROVIDER NUMBER
KY31359OtherLICENSE
KY64313596Medicaid
KY080155228Medicare PIN
KY64313596Medicaid
000000044307OtherBCBS PROVIDER NUMBER
KY01214Medicare PIN