Provider Demographics
NPI:1295530905
Name:TAYLOR, ISAAC RAY
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:RAY
Last Name:TAYLOR
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27452 DIAMOND T
Mailing Address - Street 2:
Mailing Address - City:SPLENDORA
Mailing Address - State:TX
Mailing Address - Zip Code:77372-4403
Mailing Address - Country:US
Mailing Address - Phone:832-488-2791
Mailing Address - Fax:
Practice Address - Street 1:27452 DIAMOND T
Practice Address - Street 2:
Practice Address - City:SPLENDORA
Practice Address - State:TX
Practice Address - Zip Code:77372-4403
Practice Address - Country:US
Practice Address - Phone:832-488-2791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44011389172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver