Basic Information
Provider Information
NPI: 1124178470
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAYLOR
FirstName: ROBERT
MiddleName: E
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 66737 OLD TWENTY ONE RD
Address2:  
City: CAMBRIDGE
State: OH
PostalCode: 437258987
CountryCode: US
TelephoneNumber: 7404391371
FaxNumber: 7404321954
Practice Location
Address1: 66737 OLD TWENTY ONE RD
Address2:  
City: CAMBRIDGE
State: OH
PostalCode: 437258987
CountryCode: US
TelephoneNumber: 7404391371
FaxNumber: 7404321954
Other Information
ProviderEnumerationDate: 01/11/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X35-075213OHY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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