Basic Information
| Provider Information | |||||||||
| NPI: | 1083617856 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAYLOR | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 W PLYMOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | DELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327203260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867380322 | ||||||||
| FaxNumber: | 3867380628 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 W PLYMOUTH AVE | ||||||||
| Address2: | |||||||||
| City: | DELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327203260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3867380322 | ||||||||
| FaxNumber: | 3867380628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 08/04/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207NS0135X | ME35651 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology | Procedural Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 054315200 | 05 | FL | MEDICAID |