Provider Demographics
NPI:1649272923
Name:TAYLOR, ALAN MACK II (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MACK
Last Name:TAYLOR
Suffix:II
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 REGENCY PKWY
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-7816
Mailing Address - Country:US
Mailing Address - Phone:817-419-6111
Mailing Address - Fax:817-701-4902
Practice Address - Street 1:2800 E BROAD ST STE 312
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-6412
Practice Address - Country:US
Practice Address - Phone:469-513-2666
Practice Address - Fax:469-513-2667
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-075421174400000X
LAMC09647R174400000X
TXK4586174400000X, 207RC0000X
MOR6J98174400000X
NY181909-1174400000X
KY30929174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX046202001Medicaid
TXE18739Medicare UPIN
TX8107B0Medicare PIN