Provider Demographics
NPI:1356605752
Name:TAYLOR, JEREMY S (MD)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:S
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:971 LAKELAND DR STE 450
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4615
Mailing Address - Country:US
Mailing Address - Phone:601-948-5158
Mailing Address - Fax:013-264-2656
Practice Address - Street 1:971 LAKELAND DR STE 450
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4615
Practice Address - Country:US
Practice Address - Phone:601-948-5158
Practice Address - Fax:601-326-4265
Is Sole Proprietor?:No
Enumeration Date:2012-06-29
Last Update Date:2023-05-11
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Provider Licenses
StateLicense IDTaxonomies
MS23700207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS23700OtherMISSISSIPPI STATE BOARD OF MEDICAL LICENSURE