Basic Information
Provider Information
NPI: 1619972411
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TAYLOR
FirstName: EULON
MiddleName: ROSS
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4110 GUADALUPE ST
Address2: AUSTIN STATE HOSPITAL
City: AUSTIN
State: TX
PostalCode: 787514223
CountryCode: US
TelephoneNumber: 5124192148
FaxNumber: 5124192163
Practice Location
Address1: 4110 GUADALUPE ST
Address2: AUSTIN STATE HOSPITAL
City: AUSTIN
State: TX
PostalCode: 787514223
CountryCode: US
TelephoneNumber: 5124192148
FaxNumber: 5124192163
Other Information
ProviderEnumerationDate: 06/17/2005
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
2084F0202XF7221TXY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry

No ID Information.


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