Provider Demographics
NPI:1295714038
Name:TAYLOR, ROBERT M
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14233 NORTH GOLDEN BARREL PASS
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85658
Mailing Address - Country:US
Mailing Address - Phone:318-542-6367
Mailing Address - Fax:
Practice Address - Street 1:14233 NORTH GOLDEN BARREL PASS
Practice Address - Street 2:
Practice Address - City:MARANA
Practice Address - State:AZ
Practice Address - Zip Code:85658
Practice Address - Country:US
Practice Address - Phone:318-542-6367
Practice Address - Fax:318-442-6738
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09934R208100000X
MS12544208100000X
AZ53520208100000X
LAMD.09934R208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA250004978OtherRAILROAD MEDICARE
LA1970239Medicaid
LA5R838Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER