Provider Demographics
NPI:1205878345
Name:TAYLOR, BERNARD WILLIAM JR (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:WILLIAM
Last Name:TAYLOR
Suffix:JR
Gender:M
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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:1300 N 4TH ST
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-4717
Practice Address - Country:US
Practice Address - Phone:903-757-2122
Practice Address - Fax:903-757-9475
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH28252085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8R1563OtherBLUE CROSS OF TEXAS
TX137041303Medicaid
TX137041304OtherCSCHN
TX137041301Medicaid
TX137041307Medicaid
TX137041302OtherCSCHN
TX137041307Medicaid
TX87893KMedicare PIN
TX137041303Medicaid
TX8R1563OtherBLUE CROSS OF TEXAS
TXE74489Medicare UPIN