Provider Demographics
NPI:1457386609
Name:TAYLOR, LARRY EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:EDWARD
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 1:1705 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40701-2354
Mailing Address - Country:US
Mailing Address - Phone:606-528-9772
Mailing Address - Fax:606-528-9242
Practice Address - Street 1:1705 FOREST DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2354
Practice Address - Country:US
Practice Address - Phone:606-528-9772
Practice Address - Fax:606-528-9242
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23230174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64232309Medicaid
KY000000340508OtherBCBS/WOMENS WELLNESS CTR
KY1398060OtherMAILHANDLERS
KYP00163198OtherRAILROAD MEDICARE
KSC07214OtherCHI
KY1398060OtherMAILHANDLERS
KY0935201Medicare PIN