Provider Demographics
NPI:1356929152
Name:TAYLOR, BENJAMIN MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:MICHAEL
Last Name:TAYLOR
Suffix:
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 1:852 RIDGEWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:KY
Mailing Address - Zip Code:40403-9814
Mailing Address - Country:US
Mailing Address - Phone:859-985-2656
Mailing Address - Fax:859-985-2680
Practice Address - Street 1:852 RIDGEWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:KY
Practice Address - Zip Code:40403-9814
Practice Address - Country:US
Practice Address - Phone:859-985-2656
Practice Address - Fax:859-985-2680
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY59212207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine