Provider Demographics
NPI:1982456133
Name:TAYLOR, GLENHALL ELMER IV (DO)
Entity Type:Individual
Prefix:DR
First Name:GLENHALL
Middle Name:ELMER
Last Name:TAYLOR
Suffix:IV
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:GLENHALL
Other - Middle Name:JAMES
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:350 HAWTHORNE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3108
Mailing Address - Country:US
Mailing Address - Phone:510-869-8751
Mailing Address - Fax:
Practice Address - Street 1:350 HAWTHORNE AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3108
Practice Address - Country:US
Practice Address - Phone:510-869-8751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program