Healthcare Provider Details

I. General information

NPI: 1740856871
Provider Name (Legal Business Name): TAYLOR EDWARD SMITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2021
Last Update Date: 05/30/2021
Certification Date: 04/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1514 JEFFERSON HWY
JEFFERSON LA
70121-2429
US

IV. Provider business mailing address

4813 MEADOWDALE ST
METAIRIE LA
70006-4037
US

V. Phone/Fax

Practice location:
  • Phone: 866-624-7637
  • Fax:
Mailing address:
  • Phone: 504-885-9752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: