1083935415 NPI number — FLYNN A. TAYLOR, M.D.,P.C.

Table of content: (NPI 1083935415)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083935415 NPI number — FLYNN A. TAYLOR, M.D.,P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLYNN A. TAYLOR, M.D.,P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083935415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 S PINE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DERIDDER
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70634-4840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-463-9890
Provider Business Mailing Address Fax Number:
337-462-9521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 S PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERIDDER
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70634-4840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-463-9890
Provider Business Practice Location Address Fax Number:
337-462-9521
Provider Enumeration Date:
06/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
TAYLOR
Authorized Official First Name:
FLYNN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL PHYSICIAN
Authorized Official Telephone Number:
337-463-9890

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  014367 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PENDING . This is a "MEDICARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1186384 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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