Provider Demographics
NPI:1932155629
Name:TAYLOR, LLOYD JEFF (PA)
Entity Type:Individual
Prefix:
First Name:LLOYD
Middle Name:JEFF
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 E INNES ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28146-6018
Mailing Address - Country:US
Mailing Address - Phone:704-738-2245
Mailing Address - Fax:704-738-2246
Practice Address - Street 1:1509 E INNES ST
Practice Address - Street 2:SUITE B
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28146-6018
Practice Address - Country:US
Practice Address - Phone:704-738-2245
Practice Address - Fax:704-738-2246
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101553363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S68770Medicare UPIN