Healthcare Provider Details

I. General information

NPI: 1699903781
Provider Name (Legal Business Name): BRENTLEY R TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SPRING HILL AVE STE 400
MOBILE AL
36604-1416
US

IV. Provider business mailing address

1700 SPRING HILL AVE STE 400
MOBILE AL
36604-1416
US

V. Phone/Fax

Practice location:
  • Phone: 251-438-4440
  • Fax: 251-438-4599
Mailing address:
  • Phone: 251-438-4440
  • Fax: 251-438-4599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME 123652
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberMD36097
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: