Healthcare Provider Details

I. General information

NPI: 1770552077
Provider Name (Legal Business Name): MR. LARRY WAYNE TAYLOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: LARRY W TAYLOR DO

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6554 AARON DR
FAIRFIELD AL
35214
US

IV. Provider business mailing address

2147 RIVERCHASE OFFICE RD
BIRMINGHAM AL
35244-1836
US

V. Phone/Fax

Practice location:
  • Phone: 205-786-5022
  • Fax: 205-786-5028
Mailing address:
  • Phone: 205-403-8902
  • Fax: 205-982-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO453
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: