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NPI Code Detail

MEDICARE: CHARLES MICHAEL TAYLOR II

MEDICARE: CHARLES MICHAEL TAYLOR II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician

General Provider Information

NPI Number : 1134739303
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHARLES MICHAEL TAYLOR II
Provider Business Mailing Address
First Line : 539 W COMMERCE ST STE 3000
Second Line :
City : DALLAS
State : TX
Zip : 75208-1953
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 300 E BAKER ST
Second Line :
City : CLARKSVILLE
State : TX
Zip : 75426-5034
Country : US
Telephone Number : 903-427-2236
Fax Number :
Authorized Official
Title or Position : OWNER
Name : CHARLES TAYLOR II
Credential : MD
Telephone Number : 903-517-6009
Provider Enumeration Date : 08/03/2020
Last Update Date : 08/03/2020

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