Provider Demographics
NPI:1184807406
Name:JAMES E. TAYLOR MEDICAL PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JAMES E. TAYLOR MEDICAL PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-464-9521
Mailing Address - Street 1:2102 EVANS AVE
Mailing Address - Street 2:SUITE 111
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-4095
Mailing Address - Country:US
Mailing Address - Phone:219-464-9521
Mailing Address - Fax:
Practice Address - Street 1:2102 EVANS AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-4095
Practice Address - Country:US
Practice Address - Phone:219-464-9521
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-10
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01021583208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN653910Medicare PIN