Provider Demographics
NPI:1952400491
Name:TAYLOR, ROBERT EARLE JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARLE
Last Name:TAYLOR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:323 YADKIN STREET
Mailing Address - Street 2:
Mailing Address - City:ALBEMARLE
Mailing Address - State:NC
Mailing Address - Zip Code:28001-3441
Mailing Address - Country:US
Mailing Address - Phone:704-982-1454
Mailing Address - Fax:704-982-8618
Practice Address - Street 1:323 YADKIN STREET
Practice Address - Street 2:
Practice Address - City:ALBEMARLE
Practice Address - State:NC
Practice Address - Zip Code:28001-3441
Practice Address - Country:US
Practice Address - Phone:704-982-1454
Practice Address - Fax:704-982-8618
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33158207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC81745OtherBCBS OF NC
NC8981745Medicaid
NC81745OtherBCBS OF NC
NC8981745Medicaid