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 1:2129 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94595-1618
Mailing Address - Country:US
Mailing Address - Phone:925-262-3990
Mailing Address - Fax:
Practice Address - Street 1:2129 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94595-1618
Practice Address - Country:US
Practice Address - Phone:925-262-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
MI5101028948208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program