Provider Demographics
NPI:1841720869
Name:TAYLOR PLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:TAYLOR PLASTIC SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRENTLEY
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-229-8573
Mailing Address - Street 1:350 CYPRESS BEND DRIVE
Mailing Address - Street 2:
Mailing Address - City:GULF SHORES
Mailing Address - State:AL
Mailing Address - Zip Code:36542
Mailing Address - Country:US
Mailing Address - Phone:251-967-7000
Mailing Address - Fax:251-967-7689
Practice Address - Street 1:350 CYPRESS BEND DRIVE
Practice Address - Street 2:
Practice Address - City:GULF SHORES
Practice Address - State:AL
Practice Address - Zip Code:36542
Practice Address - Country:US
Practice Address - Phone:251-967-7000
Practice Address - Fax:251-967-7689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208200000X
AL360972086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
No208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty