Healthcare Provider Details

I. General information

NPI: 1083617856
Provider Name (Legal Business Name): JAMES H TAYLOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W PLYMOUTH AVE
DELAND FL
32720-3260
US

IV. Provider business mailing address

600 W PLYMOUTH AVE
DELAND FL
32720-3260
US

V. Phone/Fax

Practice location:
  • Phone: 386-738-0322
  • Fax: 386-738-0628
Mailing address:
  • Phone: 386-738-0322
  • Fax: 386-738-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME35651
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: