Provider Demographics
NPI:1770623944
Name:JONATHAN P. TAYLOR ,MD APMC
Entity type:Organization
Organization Name:JONATHAN P. TAYLOR ,MD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GWEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NOCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-658-9890
Mailing Address - Street 1:6180 MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:ZACHARY
Mailing Address - State:LA
Mailing Address - Zip Code:70791-4069
Mailing Address - Country:US
Mailing Address - Phone:225-658-9890
Mailing Address - Fax:225-658-9019
Practice Address - Street 1:6180 MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4069
Practice Address - Country:US
Practice Address - Phone:225-658-9890
Practice Address - Fax:225-658-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14334R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1105929Medicaid
LA1427070432OtherNPI
LA=========OtherTAX ID #
LA1105929Medicaid
LA1427070432OtherNPI